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Article Dans Une Revue Journal for Immunotherapy of Cancer Année : 2023

Prognosis of immune checkpoint inhibitors-induced myocarditis: a case series

Cyrille Coustal
  • Fonction : Auteur
Juliette Vanoverschelde
  • Fonction : Auteur
Xavier Quantin
  • Fonction : Auteur
Candice Lesage
  • Fonction : Auteur
Jean-Marie Michot
  • Fonction : Auteur
Ariane Lappara
  • Fonction : Auteur
Stephane Ederhy
Eric Assenat
  • Fonction : Auteur
Maxime Faure
  • Fonction : Auteur
Nahema Issa
  • Fonction : Auteur
Olivier Lambotte
  • Fonction : Auteur
Mathieu Puyade
Olivier Dereure
  • Fonction : Auteur
Diego Tosi
  • Fonction : Auteur
Patricia Rullier
  • Fonction : Auteur
Isabelle Serre
  • Fonction : Auteur
Hélène Vernhet-Kovacsik
  • Fonction : Auteur
Jean-Luc Faillie
Audrey Agullo
  • Fonction : Auteur
Philippe Guilpain
  • Fonction : Auteur
Alexandre Thibault Jacques Maria

Résumé

Background Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last decade. Alongside this therapeutic improvement, a new variety of side effects has emerged, called immune-related adverse events (irAEs), potentially affecting any organ. Among these irAEs, myocarditis is rare but life-threatening. Methods We conducted a multicenter cross-sectional retrospective study with the aim of better characterizing ICI-related myocarditis. Myocarditis diagnosis was based on the recent consensus statement of the International Cardio-Oncology Society. Results Twenty-nine patients were identified, from six different referral centers. Most patients (55%) were treated using anti-programmed-death 1, rather than ICI combination (35%) or anti-programmed-death-ligand 1 (10%). Transthoracic echocardiography was abnormal in 52% of them, and cardiac magnetic resonance showed abnormal features in 14/24 patients (58%). Eleven patients (38%) were classified as severe. Compared with other patients, they had more frequently pre-existing systemic autoimmune disease (45% vs 6%, p=0.018), higher troponin level on admission (42-fold the upper limit vs 3.55-fold, p=0.001), and exhibited anti-acetylcholine receptor autoantibodies (p=0.001). Seven patients (24%) had myocarditis-related death, and eight more patients died from cancer progression during follow-up. Twenty-eight patients received glucocorticoids, 10 underwent plasma exchanges, 8 received intravenous immunoglobulins, and 5 other immunosuppressants. ICI rechallenge was performed in six patients, with only one myocarditis relapse. Discussion The management of ICI-related myocarditis may be challenging and requires a multidisciplinary approach. Prognostic features are herein described and may help to allow ICI rechallenge for some patients with smoldering presentation, after an accurate evaluation of benefit–risk balance.
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Dates et versions

hal-04116183 , version 1 (03-06-2023)

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Cyrille Coustal, Juliette Vanoverschelde, Xavier Quantin, Candice Lesage, Jean-Marie Michot, et al.. Prognosis of immune checkpoint inhibitors-induced myocarditis: a case series. Journal for Immunotherapy of Cancer, 2023, 11 (5), pp.e004792. ⟨10.1136/jitc-2022-004792⟩. ⟨hal-04116183⟩
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