RT Journal Article
SR Electronic
T1 Clinical characteristics, time course, treatment and outcomes of patients with immune checkpoint inhibitor-associated myocarditis
JF Journal for ImmunoTherapy of Cancer
JO J Immunother Cancer
FD BMJ Publishing Group Ltd
SP e002553
DO 10.1136/jitc-2021-002553
VO 9
IS 6
A1 Igor Puzanov
A1 Poornima Subramanian
A1 Yan V Yatsynovich
A1 David M Jacobs
A1 Maya R Chilbert
A1 Umesh C Sharma
A1 Fumito Ito
A1 Steven G Feuerstein
A1 Filip Stefanovic
A1 Benjamin Switzer
A1 Mark D Hicar
A1 Anne B Curtis
A1 Edward J Spangenthal
A1 Grace K Dy
A1 Marc S Ernstoff
A1 Pankit Vachhani
A1 Brian J Page
A1 Nikhil Agrawal
A1 Arjun Khunger
A1 Ankita Kapoor
A1 Alexander Hattoum
A1 Jerome J Schentag
YR 2021
UL http://jitc.bmj.com/content/9/6/e002553.abstract
AB Background Immune checkpoint inhibitors (ICI) have emerged as a front-line therapy for a variety of solid tumors. With the widespread use of these agents, immune-associated toxicities are increasingly being recognized, including fatal myocarditis. There are limited data on the outcomes and prognostic utility of biomarkers associated with ICI-associated myocarditis. Our objective was to examine the associations between clinical biomarkers of cardiomyocyte damage and mortality in patients with cancer treated with ICIs.Methods We retrospectively studied 23 patients who developed symptomatic and asymptomatic troponin elevations while receiving ICI therapy at a National Cancer Institute-designated comprehensive cancer center. We obtained serial ECGs, troponin I, and creatine kinase-MD (CK-MB), in addition to other conventional clinical biomarkers, and compared covariates between survivors and non-survivors.Results Among patients with myocarditis, higher troponin I (p=0.037) and CK-MB (p=0.034) levels on presentation correlated with progression to severe myocarditis. Higher troponin I (p=0.016), CK (p=0.013), and CK-MB (p=0.034) levels were associated with increased mortality, while the presence of advanced atrioventricular block on presentation (p=0.088) trended toward increased mortality. Weekly troponin monitoring lead to earlier hospitalization for potential myocarditis (p=0.022) and was associated with decreased time to steroid initiation (p=0.053) and improved outcomes.Conclusions Routine troponin surveillance may be helpful in predicting mortality in ICI-treated patients with cancer in the early phase of ICI therapy initiation. Early detection of troponin elevation is associated with earlier intervention and improved outcomes in ICI-associated myocarditis. The recommended assessment and diagnostic studies guiding treatment decisions are presented.Data are available upon reasonable request. Case level information is provided in the online supplement. All other relevant data are available from the corresponding author upon reasonable request.