Myocardial and Pericardial Toxicity Associated With Immune Checkpoint Inhibitors in Cancer Patients

Abstract

We recount a single-center experience with cardiac immunity-related adverse effects in patients treated with immune checkpoint inhibitors. Of 2,830 patients, 9 patients (0.3%) developed cardiac immunity-related adverse effects (4 cases of cardiomyopathies, 2 of myocarditis, 2 of acute pericarditis, and 1 of large pericardial effusion). Disease profiles, hospital courses, and outcomes are reported. (Level of Difficulty: Advanced.).

Keywords: CTLA, cytotoxic T-lymphocyte-associated antigen; ECG, electrocardiogram; ICI, immune checkpoint inhibitors; IRAE, immunity-related adverse effects; PD, programmed cell death receptor; PDL, programmed cell death ligand; cardiotoxicity; immune checkpoint inhibitors; immunity-related adverse events.

Graphical abstract

Figure 1

Spontaneous Resolution of Large Pericardial Effusion After 3 Days of Ibuprofen and Colchicine Therapy (Case 8) Echocardiography parasternal long view (A and C) and 4-chamber views (B and D). On presentation (A and B): large circumferential pericardial effusion (green arrows) and large pleural effusion (blue arrow). The descending aorta (orange arrow) helps to differentiate the 2 effusions. At 2 days after presentation (C and D): spontaneous resolution of pericardial effusion (green arrows) and persistence of pleural effusion (blue arrow).