Cardiotoxicity of immunotherapy in lung cancer in light of new ESC guidelines
 
More details
Hide details
1
1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
 
2
Students’ Scientific Club, 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
 
 
Corresponding author
Gabriela B. Orzeł   

1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, ul. Ziołowa 45/47, 40-635 Katowice
 
 
Ann. Acad. Med. Siles. 2023;77:137-145
 
KEYWORDS
TOPICS
ABSTRACT
There has been rapid development of anticancer therapies involving monoclonal antibodies targeting immune checkpoints of the immune response. One of them is pembrolizumab (the anti-programmed death receptor 1 ligand – anti-PD-1) used in the treatment of malignant melanoma, non-small cell lung cancer, or triple-negative breast cancer, among others. The case presented in this paper refers to a patient suffering from adenocarcinoma of the lung with multiple metastases and associated diseases. During immunotherapy with pembrolizumab, acute myocarditis was diagnosed. The clinical course of this case study specifically demonstrates how important, in the context of oncology patients treated with immunotherapy, the continuous evaluation and control are of the occurrence of adverse toxic effects associated with anticancer treatment. First of all, potential PD-1 inhibitor cardiotoxicity is rare in patients undergoing therapy with this drug, which significantly hinders accurate differential diagnosis in this direction. Second, this adverse effect, although relatively rare, is often fatal. The following case study describes how, with high doses of glucocorticosteroids, the effects of pembrolizumab-induced toxicity can be effectively muted.
REFERENCES (20)
1.
Pilleron S., Soto‐Perez‐de‐Celis E., Vignat J., Ferlay J., Soerjomataram I., Bray F. et al. Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int. J. Cancer 2021; 148(3): 601–608, doi: 10.1002/ijc.33232.
 
2.
Pilleron S., Sarfati D., Janssen-Heijnen M., Vignat J., Ferlay J., Bray F. et al. Global cancer incidence in older adults, 2012 and 2035: A population-based study. Int. J. Cancer 2019; 144(1): 49–58, doi: 10.1002/ijc.31664.
 
3.
Chaturvedi V.K., Singh A., Singh V.K., Singh M.P. Cancer nanotechnology: A new revolution for cancer diagnosis and therapy. Curr. Drug Metab. 2019; 20(6): 416–429, doi: 10.2174/1389200219666180918111528.
 
4.
Chaft J.E., Rimner A., Weder W., Azzoli C.G., Kris M.G., Cascone T. Evolution of systemic therapy for stages I–III non-metastatic non-small-cell lung cancer. Nat. Rev. Clin. Oncol. 2021; 18(9): 547–557, doi: 10.1038/s41571-021-00501-4.
 
5.
Reck M., Rodríguez-Abreu D., Robinson A.G., Hui R., Csőszi T., Fülöp A. et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small cell lung cancer. N. Engl. J. Med. 2016; 375(19): 1823–1833, doi: 10.1056/NEJMoa1606774.
 
6.
Upadhrasta S., Elias H., Patel K., Zheng L. Managing cardiotoxicity associated with immune checkpoint inhibitors. Chronic Dis. Transl. Med. 2019; 5(1): 6–14, doi: 10.1016/j.cdtm.2019.02.004.
 
7.
Varricchi G., Galdiero M.R., Marone G., Criscuolo G., Triassi M., Bonaduce D. et al. Cardiotoxicity of immune checkpoint inhibitors. ESMO Open 2017; 2(4): e000247, doi: 10.1136/esmoopen-2017-000247.
 
8.
Gadgeel S., Rodríguez-Abreu D., Speranza G., Esteban E., Felip E., Dómine M. et al. Updated analysis from KEYNOTE-189: pembrolizumab or placebo plus pemetrexed and platinum for previously untreated metastatic nonsquamous non-small-cell lung cancer. J. Clin. Oncol. 2020; 38(14): 1505–1157, doi: 10.1200/JCO.19.03136.
 
9.
Mascolo A., Scavone C., Ferrajolo C., Rafaniello C., Danesi R., Del Re M. et al. Immune checkpoint inhibitors and cardiotoxicity: An analysis of spontaneous reports in eudravigilance. Drug Saf. 2021; 44(9): 957–971, doi: 10.1007/s40264-021-01086-8.
 
10.
Johnson D.B., Chandra S., Sosman J.A. Immune checkpoint inhibitor toxicity in 2018. JAMA 2018; 320(16): 1702–1703, doi: 10.1001/jama.2018.13995.
 
11.
Lyon A.R., López-Fernández T., Couch L.S., Asteggiano R., Aznar M.C., Bergler-Klein J. et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur. Heart J. 2022; 43(41): 4229–4361, doi: 10.1093/eurheartj/ehac244.
 
12.
Thakker R.A., Lee M.A., Albaeni A., Elbadawi A., Suthar K.H., Perez C. et al. Clinical characteristics and outcomes in immune checkpoint inhibitor therapy-associated myocarditis. Cardiol. Res. 2021; 12(5): 270–278, doi: 10.14740/cr1319.
 
13.
Läubli H., Balmelli C., Bossard M., Pfister O., Glatz K., Zippelius A. Acute heart failure due to autoimmune myocarditis under pembrolizumab treatment for metastatic melanoma. J. Immunother. Cancer 2015; 3: 11, doi: 10.1186/s40425-015-0057-1.
 
14.
Ammirati E., Lupi L., Palazzini M., Hendren N.S., Grodin J.L., Cannistraci C.V. et al. Prevalence, characteristics, and outcomes of COVID-19-associated acute myocarditis. Circulation 2022; 145(15): 1123–1139, doi: 10.1161/CIRCULATIONAHA.121.056817.
 
15.
Sh Ahmed O., Mahadevia H., Manochakian R., Zhao Y., Salinas M., Khoor A. et al. A Case of full recovery from prolonged cardiac arrest after infusion with paclitaxel and pembrolizumab. Case Rep. Oncol. 2022; 15(3): 1063–1073, doi: 10.1159/000527205.
 
16.
Agdamag A.C.C., Edmiston J.B., Charpentier V., Chowdhury M., Fraser M., Maharaj V.R. et al. Update on COVID-19 myocarditis. Medicina (Kaunas) 2020; 56(12): 678, doi: 10.3390/medicina56120678.
 
17.
Matsumoto T., Fukuda K., Yoshida T., Shimazu K., Taguchi D., Shinozaki H. et al. Sudden and severe cardiotoxicity induced with pembrolizumab, its clinical course, therapeutic intervention, and outcome. Int. Cancer Conf. J. 2022; 11(1): 81–86, doi: 10.1007/s13691-021-00525-8.
 
18.
Su L., Liu C., Wu W., Cui Y., Wu M., Chen H. Successful therapy for myocarditis concomitant with complete heart block after pembrolizumab treatment for head and neck squamous cell carcinoma: A case report with literature review. Front Cardiovasc. Med. 2022; 9: 898756, doi: 10.3389/fcvm.2022.898756.
 
19.
Jang S.Y., Lee S.Y., Lee H.L., Choi J. Early development of pembrolizumab-induced fulminant myositis and cardiotoxicity in a patient with metastatic thymoma. Respirol. Case Rep. 2022; 10(9): e01025, doi: 10.1002/rcr2.1025.
 
20.
Hu C., Zhao L., Zhou C., Wang H., Jiang S., Li Y. et al. Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block. Open Med. (Wars) 2022; 17(1): 2109–2116, doi: 10.1515/med-2022-0611.
 
eISSN:1734-025X
Journals System - logo
Scroll to top