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Review
. 2023 Nov 3;59(11):1946.
doi: 10.3390/medicina59111946.

Tolerated Re-Challenge of Immunotherapy in a Patient with ICI Associated Myocarditis: A Case Report and Literature Review

Walid Shalata  1   2 , Zoé Gabrielle Attal  3 , Rajeh Shhadi  2 , Amjad Abu Salman  4 , Ashraf Abu Jama  1   2 , Sondos Shalata  5 , Kais Halumi  1 , Alexander Yakobson  1   2
Affiliations
Review

Tolerated Re-Challenge of Immunotherapy in a Patient with ICI Associated Myocarditis: A Case Report and Literature Review

Walid Shalata et al. Medicina (Kaunas). .

Abstract

Many different types of cancer can be treated with immunotherapy drugs called immune checkpoint inhibitors (ICIs). These drugs have altered the landscape of cancer treatment options since they function by triggering a stronger immune response to malignancy. As expected, ICIs' modification of immune regulatory controls leads to a wide range of organ/gland-specific immune-related side effects. These adverse effects are uncommonly deadly and typically improve by discontinuing treatment or administering corticosteroid drugs. As a result of a number of factors-including a lack of specificity in the clinical presentation, the possibility of overlap with other cardiovascular and general medical illnesses, difficulties in diagnosis, and a general lack of awareness-the true incidence of ICI-associated myocarditis is likely underestimated. Currently, protocols for the surveillance, diagnosis, or treatment of this condition are unclear. Several questions remain unanswered, such as how to best screen for this rare toxin, what tests should be run on patients who are suspected of having it, how to treat myocarditis once it has developed, and who is at most risk. In this article, we provide a case study of ICI-associated myocarditis and explain its key characteristics and treatment options.

Keywords: cardiac toxicity; cytotoxic T-lymphocyte-associated protein 4 (CTLA-4); immune checkpoint inhibitors (ICIs); immune-related adverse events (IRAE); inhibitors; myocarditis; programmed cell death protein 1 (PD-1); programmed death-ligand 1 (PD-L1).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PET–CT scan showing hypermetabolic absorption in the vertebrae area (red arrow).
Figure 2
Figure 2
Electrocardiography, angiogram of the coronary arteries showing no pathological findings.
Figure 3
Figure 3
MRI of the heart, showing LGE in inferior lateral left ventricular (red arrows) (A). In addition, minimal pericardial effusion was noted (red arrows) (B).
Figure 4
Figure 4
PET–CT scan showing no evidence of disease.
See this image and copyright information in PMC

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