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An Emergent Form of Cardiotoxicity: Acute Myocarditis Induced by Immune Checkpoint Inhibitors

机译:心肌毒性的紧急形式:免疫检查点抑制剂诱导的急性心肌炎

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摘要

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. ICIs have shown great promise in the treatment of several advanced malignancies. However, therapy with these immunomodulatory antibodies may lead to a wide spectrum of immune-related adverse events in any organ and any tissue. Cardiologic immune-related events include pericarditis, pericardial effusion, various types of arrhythmias including the occurrence of complete atrioventricular block, myocardial infarction, heart failure, and myocarditis. Although relatively rare, myocarditis is associated with a very high reported mortality in comparison to other adverse events. Myocarditis often presents significant diagnostic complexity and may be under-recognized. When confronted with an unexpected change in the clinical picture, the physician must differentiate between immune-related adverse events, cancer worsening, or other causes unrelated to the cancer or its therapy. However, this is not always easy. Therefore, with the increasing use of checkpoint inhibitors in cancer, all providers who care for patients with cancer should be made aware of this rare, but potentially fatal, cardiologic immune-related adverse event, and able to recognize when prompt consultation with a cardiologist specialist is indicated. In this review, we evaluate currently available scientific evidence and discuss clinical manifestations and new potential approaches to the diagnosis and therapy of acute myocarditis induced by ICIs. Temporary or permanent discontinuation of the ICIs and high-dose steroids have been administered to treat myocarditis, but symptoms may worsen in some patients despite therapy.
机译:免疫检查点抑制剂(ICIS)是激活免疫系统的单克隆抗体,旨在提高抗肿瘤免疫力。 ICIS在治疗若干晚期恶性肿瘤的治疗方面表现出了很大的承诺。然而,具有这些免疫调节抗体的治疗可能导致任何器官和任何组织中的宽免疫相关不良事件。心脏病有关的事件包括心包炎,心包积液,各种类型的心律失常,包括完整的房室间块,心肌梗塞,心力衰竭和心肌炎的发生。虽然比较罕见,但与其他不良事件相比,心肌炎与据报道的死亡率非常高。心肌炎往往具有显着的诊断复杂性,并且可能被公认。在临床图中面对意想不到的变化时,医生必须区分免疫相关的不良事件,癌症恶化或与癌症无关的其他原因。但是,这并不总是容易的。因此,随着癌症在检查点抑制剂的增加,所有照顾癌症患者的所有提供商都应该了解这种罕见的,但可能致命的,心脏病的免疫相关的不良事件,并且能够批准与心脏病专家迅速咨询时表示。在这篇综述中,我们评估目前可用的科学证据,并讨论ICIS诱导急性心肌炎的诊断和治疗的临床表现和新的潜在方法。已经施用临时或永久停止ICIS和高剂量类固醇以治疗心肌炎,但尽管有治疗,但某些患者可能会恶化。

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