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Case Reports
. 2022 Aug 26:13:995121.
doi: 10.3389/fimmu.2022.995121. eCollection 2022.

Sintilimab induced ICIAM in the treatment of advanced HCC: A case report and analysis of research progress

Hongxiang Ji  1 , Zhijian Wen  1 , Bin Liu  1 , Hongbiao Chen  1 , Qian Lin  1 , Zhan Chen  1
Affiliations
Case Reports

Sintilimab induced ICIAM in the treatment of advanced HCC: A case report and analysis of research progress

Hongxiang Ji et al. Front Immunol. .

Abstract

Immune checkpoint inhibitor-associated adverse reactions (irAEs) are a clinical treatment issue that requires additional attention when ICIs have significant survival benefits in patients with advanced hepatocellular carcinoma (HCC). Among them, ICIs-associated myocarditis (ICIAM) is a kind of severe irAE with a high mortality rate (17%-50%). Despite its low incidence (PD1/PD-L1 related: 0.41%-0.8%), ICIAM can significantly disturb the decision making of therapeutic schemes and even the survival outcomes of patients. ICIAM induced by sintilimab has not been reported in any complete clinical studies yet and understanding the clinical characteristics involved may inform better practices for the management. Here, we reported a 78 y/o patient with advanced HCC, who experienced ICIAM induced by sintilimab within a short course from treatment onset and found that adequate baseline examination before the implementation of the therapeutic scheme, regular monitoring of myocardial enzymonram and cardiac imaging were measures for the early detection, while glucocorticoid pulse therapy is still the best choice with timely and sufficient application. Simultaneously, the combination of other immunosuppressants may lead to better results. New-predictive markers and examination methods are still required to facilitate the early detection.

Keywords: ICI-associated myocarditis (ICIAM); hepatocellular carcinoma (HCC); immune checkpoint inhibitor-associated adverse reactions (irAEs); programmed cell death receptor 1/ligand 1 (PD-1/PD-L1); sintilimab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The rapid progress of the ECG of the patient’s within 4 days. (A) PI and II were upright; Pav was inverted. QRS widened equal to or longer than 0.12 s; V1rsR; QRS terminal in each lead was blunt and ST-T was changed secondary. (B) PI and II were upright; Pav was inverted; QRS was widened equal to or longer than 0.12 s; V1 rsR; II, III, aVF were changed to rS type; S III >S II; I, aVL leads were qR type; R avL >R I; QRS electrical axis was left biased. (C) Sinus heart rate; high atrioventricular block; abnormal Q-waves appeared in V2–V3 leads.
Figure 2
Figure 2
The changes in serum enzyme levels during the treatment (x-axis = date, y-axis = units symbols).
Figure 3
Figure 3
Timeline of disease diagnosis and treatment.
See this image and copyright information in PMC

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