Steroid-Refractory Myocarditis Induced by Immune Checkpoint Inhibitor Responded to Infliximab: Report of Two Cases and Literature Review

IF 3.4 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Toxicology Pub Date : 2024-09-10 DOI:10.1007/s12012-024-09918-6
Sihan Tan, Chang Qi, Hao Zeng, Qi Wei, Qin Huang, Xin Pu, Weimin Li, Yalun Li, Panwen Tian
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Abstract

Immune checkpoint inhibitors (ICIs), including anti-programmed cell death protein 1 and its ligand (PD-1/PD-L1) as well as anti-cytotoxic T lymphocyte-associated protein 4 (CTLA-4), have been widely used for treating solid tumors. Myocarditis is a potentially lethal immune-related adverse events (irAEs) caused by ICIs therapy. The treatment of steroid-refractory myocarditis is challenging. We reported two non-small-cell lung cancer patients with steroid-refractory myocarditis induced by ICI. The symptoms were not resolved after pulse corticosteroid therapy and subsequent treatment including intravenous immunoglobulin and mycophenolate mofetil. Considering the level of serum interleukin (IL)-6 decreased by > 50% and level of serum tumor necrosis factor-α (TNF-α) increased during the course of the disease, infliximab was used. Myocarditis gradually alleviated after infliximab treatment. The cases revealed that specific cytokine inhibitors have promising roles in the treatment of steroid-refractory myocarditis. Infliximab could be considered for patients with low level of IL-6 and elevated level of TNF-α.

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免疫检查点抑制剂诱发的类固醇难治性心肌炎对英夫利西单抗有反应:两个病例的报告和文献综述
免疫检查点抑制剂(ICIs),包括抗程序性细胞死亡蛋白1及其配体(PD-1/PD-L1)以及抗细胞毒性T淋巴细胞相关蛋白4(CTLA-4),已被广泛用于治疗实体瘤。心肌炎是 ICIs 治疗引起的潜在致命性免疫相关不良事件(irAEs)。类固醇难治性心肌炎的治疗具有挑战性。我们报告了两名由 ICI 诱发的类固醇难治性心肌炎的非小细胞肺癌患者。经过脉冲皮质类固醇治疗以及静脉注射免疫球蛋白和霉酚酸酯等后续治疗后,症状仍未缓解。考虑到病程中血清白细胞介素(IL)-6 水平下降了 50%,血清肿瘤坏死因子-α(TNF-α)水平升高,患者使用了英夫利昔单抗。英夫利昔单抗治疗后,心肌炎逐渐缓解。这些病例表明,特异性细胞因子抑制剂在类固醇难治性心肌炎的治疗中大有可为。对于IL-6水平较低而TNF-α水平较高的患者,可以考虑使用英夫利西单抗。
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来源期刊
Cardiovascular Toxicology
Cardiovascular Toxicology 医学-毒理学
CiteScore
6.60
自引率
3.10%
发文量
61
审稿时长
>12 weeks
期刊介绍: Cardiovascular Toxicology is the only journal dedicated to publishing contemporary issues, timely reviews, and experimental and clinical data on toxicological aspects of cardiovascular disease. CT publishes papers that will elucidate the effects, molecular mechanisms, and signaling pathways of environmental toxicants on the cardiovascular system. Also covered are the detrimental effects of new cardiovascular drugs, and cardiovascular effects of non-cardiovascular drugs, anti-cancer chemotherapy, and gene therapy. In addition, Cardiovascular Toxicology reports safety and toxicological data on new cardiovascular and non-cardiovascular drugs.
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