Abstract
Immune checkpoint inhibitors (ICIs) have improved the management and the prognosis
of patients with cancer but are associated with an increased risk of toxicities that
can affect every organ. ICI-associated myocarditis has a low incidence (< 1%) but
a high fatality rate (30%-50%). Herein we report a patient treated with ICI admitted
for suspicion of myocarditis. Cardiac magnetic resonance imaging (cMRI) was normal.
An endomyocardial biopsy (EMB) was in favour of ICI-related myocarditis with cardiac
lymphohistiocytic infiltrate. This case highlights the role of a systematic evaluation
with electrocardiography and troponin and the potential value of EMB in patients without
a suggestive cMRI.
Résumé
Les inhibiteurs de points de contrôle immunitaire (ICI) ont amélioré la prise en charge
et le pronostic des patients atteints de cancer, mais ils sont associés à un risque
accru de toxicités qui peuvent toucher tous les organes. La myocardite associée aux
ICI a une faible incidence (< 1 %) mais un taux de létalité élevé (30 %-50 %). Nous
rapportons ici le cas d'un patient traité par ICI et admis pour suspicion de myocardite.
L'imagerie par résonance magnétique cardiaque (IRMc) était normale. Une biopsie endomyocardique
(BEM) statuait en faveur d'une myocardite liée à l'ICI avec un infiltrat lymphohistiocytaire
cardiaque. Ce cas souligne le bien-fondé d'une évaluation systématique avec électrocardiographie
et dosage de la troponine et de la plus-value potentielle de la BEM chez les patients
sans IRMc manifeste.
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References
- Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis.Eur Heart J. 2020; 41: 1733-1743
- Myocarditis in the setting of cancer therapeutics: proposed case definitions for emerging clinical syndromes in cardio-oncology.Circulation. 2019; 140: 80-91
- Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis.JAMA Oncol. 2018; 4: 1721-1728
- Cardiovascular toxicities associated with immune checkpoint inhibitors: an observational, retrospective, pharmacovigilance study.Lancet Oncol. 2018; 19: 1579-1589
Article info
Publication history
Published online: December 25, 2020
Accepted:
December 19,
2020
Received:
July 15,
2020
Footnotes
See page 1656 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
