ABC Heart Fail Cardiomyop 2023; 3(1): e20230025
Advances in Diagnosis and Treatment of Cancer Immunotherapy and CAR-T Cell–Related Myocarditis
Ariane Vieira Scarlatelli Macedo
, Aurea Grippa
, Katia Regina Medeiros Luz
, Nathalia Coelho de Castro Nunes
, Sandrigo Mangini
Immune checkpoint inhibitors
The incidence of myocarditis in patients using ICI is low, around 1%. However, several series describe mortality between 30% and 40%. This is the primary reason that every effort is made for myocardial protection and early identification of signs of inflammatory response onset, in addition to understanding of T cell and macrophage stimulation and cytokine production., The onset of the lesion is most frequently observed observed early after the first dose of immunotherapy with a median time to onset of 30 days, with an average resolution of 90 to 120 days. Patients over 60 years of age are the most affected in the majority of series.
Patients with suspected ICI-associated myocarditis may develop from asymptomatic conditions with increased biomarkers to severe presentations including cardiogenic shock, ventricular arrhythmias, and sudden death. Dyspnea and asthenia are the most common complaints related to ICI-associated myocarditis; chest pain may also occur. The combination of ICI appears to be an important risk factor compared to monotherapy.
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