Clinical and pathological characteristics of immune checkpoint inhibitor-related fulminant myocarditis

Ryo Izumi; Toru Hashimoto; Hiroshi Kisanuki; Kei Ikuta; Wataru Otsuru; Soshun Asakawa; Shoei Yamamoto; Kayo Misumi; Takeo Fujino; Keisuke Shinohara; Shouji Matsushima; Kazuya Hosokawa; Shunsuke Katsuki; Taro Mori; Mikiko Hashisako; Yuki Tateishi; Takeshi Iwasaki; Yoshinao Oda; Shintaro Kinugawa; Kohtaro Abe

doi:10.1186/s40959-024-00288-0

Clinical and pathological characteristics of immune checkpoint inhibitor-related fulminant myocarditis

Cardiooncology. 2024 Nov 21;10(1):82. doi: 10.1186/s40959-024-00288-0.

Authors

Ryo Izumi¹, Toru Hashimoto², Hiroshi Kisanuki¹, Kei Ikuta¹, Wataru Otsuru¹, Soshun Asakawa¹, Shoei Yamamoto¹, Kayo Misumi¹, Takeo Fujino^{1

3}, Keisuke Shinohara¹, Shouji Matsushima¹, Kazuya Hosokawa¹, Shunsuke Katsuki¹, Taro Mori^{4

5}, Mikiko Hashisako^{4

5}, Yuki Tateishi^{4

5

6}, Takeshi Iwasaki^{4

5}, Yoshinao Oda^{4

5}, Shintaro Kinugawa¹, Kohtaro Abe¹

Affiliations

¹ Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Clinical Research Building B 416, Higashi-Ku, Fukuoka, 812-8582, Japan.
² Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Clinical Research Building B 416, Higashi-Ku, Fukuoka, 812-8582, Japan. hashimoto.toru.655@m.kyushu-u.ac.jp.
³ Department of Advanced Cardiopulmonary Failure, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁴ Department of Anatomic Pathology, Pathological Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁵ Division of Diagnostic Pathology, Kyushu University Hospital, Fukuoka, Japan.
⁶ Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.

Abstract

The advent of immune checkpoint inhibitors (ICIs) has significantly improved cancer treatment. With the increasing use of ICIs, ICI-related myocarditis has been recognized. However, an evidence-based therapeutic strategy has not been established because of the limited knowledge on ICI-related myocarditis. Here, we present four cases of ICI-related fulminant myocarditis (FM). Three of the four cases resulted in fatal outcomes despite aggressive treatment with mechanical circulatory support and immunosuppressive therapy with corticosteroids. Given the poor prognosis of ICI-FM, the establishment of rapid and adequate therapeutic interventions on the basis of clinical and pathological evaluation is imperative.

Keywords: Cardiogenic shock; Fulminant myocarditis; Immune checkpoint inhibitors,; Immune-related adverse events; Mechanical circulatory support; Ventricular arrhythmia.