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. 2025 Feb 5:216:115186.
doi: 10.1016/j.ejca.2024.115186. Epub 2024 Dec 15.

Optimized monitoring for immune checkpoint inhibitor induced myocarditis using high-sensitivity troponin-T

Dirk Tomsitz  1 , Ulrich Grabmaier  2 , Judith Spiro  3 , Leo Nicolai  4 , Lars E French  5 , Steffen Massberg  2 , Lucie Heinzerling  6
Affiliations
Free article

Optimized monitoring for immune checkpoint inhibitor induced myocarditis using high-sensitivity troponin-T

Dirk Tomsitz et al. Eur J Cancer. .
Free article

Abstract

Background: Immune checkpoint inhibitor (ICI)-induced Myocarditis (irMyocarditis) is a rare adverse event with a high mortality rate of 40-50 % and which is mostly not diagnosed until clinical symptoms emerge.

Objectives: This study aims to screen patients for irMyocarditis using high-sensitivity cardiac troponin-T (hs-TnT) before and regularly during therapy with ICI.

Methods: A cohort of 280 cancer patients were prospectively screened for levels of hs-TnT at baseline and prior to every ICI infusion. In case of elevation of hs-TnT, patients were referred for further work-up.

Results: In total, 196 patients exhibited a baseline hs-TnT ≤ 14 ng/l (99th percentile concentration for general population; group A) and 84 patients a hs-TnT > 14 ng/l at baseline (group B). An increase of hs-TnT during ICI-treatment was observed in 56 out of 196 (27.6 %) and 56 out of 84 patients (66.7 %) in group A and B. Cardiovascular assessment was performed in 11.2 % and 27.4 % of patients, respectively, and 4.1 % and 9.5 % of patients were diagnosed with irMyocarditis and treated with corticosteroids. No fatalities occurred in any of the 16 irMyocarditis patients. Defining a threshold with the highest sensitivity and maximum specificity in receiver-operating characteristics curves, identified a limit of 22 ng/l (group A) and 60 ng/l (group B) hs-TnT, associated with a sensitivity of 100 % in both and a specificity of 91.0 % and 89.6 %, respectively, to detect irMyocarditis.

Conclusion: Screening of hs-TnT can identify irMyocarditis early and lead to reduction of MACE and mortality risk through interruption of ICI-treatment and prompt therapy with corticosteroids.

Keywords: High-sensitivity troponin-T; Immune checkpoint inhibitors; Major adverse cardiac event; Myocarditis.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dirk Tomsitz reports consultancy, speaker fees or travel grants: BMS, Roche, Novartis, Sanofi, Recordati, Kyowa Kirin, Sun Pharma, Recordati and Pierre Fabre. Lucie Heinzerling reports consultancy, speaker fees, travel grants and/or research funding: BMS, MSD, Merck, Roche, Amgen, Curevac, Novartis, Sanofi and Pierre Fabre; clinical studies: BMS, MSD, Merck, Roche, Amgen, GSK, Curevac and Novartis. All remaining authors have declared no conflict of interest.