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. 2022 May;14(7):511-520.
doi: 10.2217/imt-2021-0225. Epub 2022 Mar 24.

Immune checkpoint inhibitor-induced myocarditis, myositis, myasthenia gravis and transaminitis: a case series and review

Derrick Ho Wai Siu  1   2   3 , Robert Sean O'Neill  3   4 , Carole A Harris  1   3   4 , Justine Wang  3   5   6 , Luke Ardolino  3   7 , Teesha Downton  8 , Matthew Tong  4 , Jun Hee Hong  1 , Venessa Chin  7   9 , Philip R Clingan  8   10 , Morteza Aghmesheh  8   10 , Hussein Soudy  1   3   4
Affiliations

Immune checkpoint inhibitor-induced myocarditis, myositis, myasthenia gravis and transaminitis: a case series and review

Derrick Ho Wai Siu et al. Immunotherapy. 2022 May.

Abstract

Immune checkpoint inhibitors have been incorporated into the treatment of various malignancies. An increasing body of literature is reporting rare but potentially fatal adverse events associated with these agents. In this case series, the authors report the clinical features and outcomes of seven patients who received immune checkpoint inhibitors for different solid organ malignancies and developed a tetrad of immune-related myocarditis, myositis, myasthenia gravis and transaminitis. Herein the authors review the literature and describe the current diagnostic and management approach for this overlapping syndrome. The authors' series highlights the importance of a high index of clinical suspicion, prompt comprehensive investigations, early multidisciplinary team involvement and initiation of immunosuppressive therapy when immune-related adverse events are suspected.

Keywords: immune checkpoint inhibitors; immune-related adverse events; immunotherapy; myasthenia; myocarditis; myositis; transaminitis.

Plain language summary

Cancer immunotherapy is used in the treatment of different cancer types. Immunotherapy activates the immune system to detect and attack cancer cells, but side effects may arise from the immune system inadvertently attacking normal tissues and organs. The increased use of immunotherapy has led to an increase in the reporting of rare but potentially life-threatening treatment-related side effects. In this case series, the authors report the clinical features and outcomes of seven patients who developed inflammation of the heart, muscles, nerve and muscle junctions and liver following treatment with immunotherapy. The authors review the scientific literature and discuss the current understanding of and management approach to this rare syndrome. The authors' report highlights the importance of a high degree of clinical suspicion, prompt comprehensive testing to confirm diagnosis, early involvement of experts from different specialties and early initiation of treatment in the management of this unique syndrome.

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