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Immune checkpoint inhibitor-associated myocarditis: from pathophysiology to rechallenge of therapy – a narrative review

    Andrea Tedeschi

    *Author for correspondence:

    E-mail Address: andrea.tedeschimd@gmail.com

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Massimiliano Camilli

    Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, 00168, Italy

    ,
    Enrico Ammirati

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Piero Gentile

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Matteo Palazzini

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Nicolina Conti

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Alessandro Verde

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Gabriella Masciocco

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Grazia Foti

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    ,
    Cristina Giannattasio

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    &
    Andrea Garascia

    “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy

    Published Online:https://doi.org/10.2217/fca-2022-0120

    Even if immune checkpoint inhibitors have revolutionized the landscape of cancer therapy, their use may be complicated by immune-related adverse events. Among these, myocarditis is the most severe complication. The clinical suspicion often arises after clinical symptoms onset and increase in cardiac biomarkers or electrocardiographic manifestations. Echocardiography and cardiac magnetic resonance imaging are recommended for each patient. However, since they may be misleadingly normal, endomyocardial biopsy remains the gold standard for establishing the diagnosis. Until now, treatment has been based on glucocorticoids even if increasing interest has risen in other immunosuppressive agents. Although myocarditis currently imposes immunotherapy discontinuation, case reports have suggested a safety rechallenge in low-grade myocarditis paving the way for further studies to respond to this unmet clinical need.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

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