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Case Reports
. 2019 Mar 21;12(1):260-276.
doi: 10.1159/000498985. eCollection 2019 Jan-Apr.

Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: Case Series and Review of the Literature

Nikhil Agrawal  1 , Arjun Khunger  2 , Pankit Vachhani  3 , Teresa A Colvin  1 , Alexander Hattoum  1 , Edward Spangenthal  3 , Anne B Curtis  1 , Grace K Dy  1   3 , Marc S Ernstoff  1   3 , Igor Puzanov  3
Affiliations
Case Reports

Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: Case Series and Review of the Literature

Nikhil Agrawal et al. Case Rep Oncol. .

Abstract

The development of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of patients with advanced stage cancers. However, immune-related adverse events are frequently observed. Cardiac toxicity from ICI therapy can range from asymptomatic troponin-I elevations to conduction abnormalities of the heart and even fulminant myocarditis. Although rare, myocarditis is a potentially fatal adverse effect of ICI therapy. We present a series of five cases of ICI-related cardio-toxicity diagnosed and managed at Roswell Park Comprehensive Cancer Center along with a review of published case reports in the literature. Our series highlights the importance of high clinical suspicion, early diagnosis of myocarditis, and prompt initiation of immunosuppressive therapy.

Keywords: Autoimmune; Cardio-oncology; Cardiotoxicity; Immune checkpoint inhibitors; Myocarditis.

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Figures

Fig. 1.
Fig. 1.
Case 1: EKG changes observed on day 32 after 1 dose of pembrolizumab 200 mg infusion showing left bundle branch block (a) and right bundle branch block (b).
Fig. 2.
Fig. 2.
Case 3: EKG changes observed on day 12 after 1 dose of pembrolizumab 2 mg/kg infusion showing right bundle branch block.
Fig. 3.
Fig. 3.
Case 4: Cardiac MRI showed T2 intramyocardial intensity consistent with edema and early gadolinium enhancement, consistent with the Lake Louise Criteria for myocarditis.
Fig. 4.
Fig. 4.
Case 4: Autopsy specimen of the heart demonstrating multiple white tumor metastatic nodules in the right atrium.
See this image and copyright information in PMC

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