scholarly journals Retrospective Analysis of Treatment and Complications of Immune Checkpoint Inhibitor-Associated Colitis: Histological Ulcerations as Potential Predictor for a Steroid-Refractory Disease Course

2020 ◽  
Vol 5 (3) ◽  
pp. 109-116 ◽  
Author(s):  
Julian Burla ◽  
Sena Bluemel ◽  
Luc Biedermann ◽  
Marjam J. Barysch ◽  
Reinhard Dummer ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Refractory Disease ◽  
Disease Course ◽  
Potential Predictor ◽  
Steroid Refractory

Predictors of steroid-refractory immune checkpoint inhibitor associated myocarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Power ◽  
W Meijers ◽  
C Fenioux ◽  
Y Tamura ◽  
A Asnani ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Adverse Events ◽  
Myasthenia Gravis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Funding Source ◽  
Daily Dose ◽  
Age And Sex ◽  
Steroid Refractory

Abstract Background/Introduction Immune checkpoint inhibitor (ICI)-associated myocarditis has a high mortality rate of approximately 50%. Clinical decompensation often occurs despite first-line treatment with corticosteroids. Factors associated with steroid failure are currently unknown. Purpose To identify predictors of steroid failure in patients with ICI-associated myocarditis. Methods We developed a web-based registry to collect and study 157 cases with clinical manifestations of ICI-associated myocarditis across 16 countries. Steroid failure was defined as patients who were escalated to immunomodulators after ≥1mg/kg daily dose of prednisone or had in-hospital death due to myocarditis despite ≥1mg/kg daily dose of prednisone. Steroid response was defined as all other patients treated with steroids without escalation to immunomodulators and without death due to myocarditis. A multivariate logistic model accounting for age and sex was used to predict association with steroid failure. Results Compared to steroid responsive cases, steroid failure was more likely to result in fulminant myocarditis (56.7% vs 19.6%, OR=5.37 [2.62–10.98] p<0.001) and all-cause in-hospital mortality (49.1% vs 12.9%, OR=6.50 [2.86–14.73] p<0.001) with shorter time from presentation to death (27.5 vs 43.0 days HR: 2.56 [1.45–4.50] p=0.001). When adjusting for age and sex, cases were more likely to be steroid-refractory if they were female (46.7% vs 30.1%, OR=2.77 [1.31–5.85] p=0.007), higher body mass index (27.2 vs 22.0, OR=1.09 [1.01–1.18] p=0.012), had higher intake creatine kinase (2800.5 vs 528.0 U/L, OR=1.48 [1.14–1.90] p=0.003) had higher intake troponin T (1.40 vs 0.25 ng/mL OR=1.63 [1.00–2.64] p=0.049), or had one or more concomitant non-cardiac immune-related adverse event (90.0% vs 74.2%, OR=3.10 [1.14–8.25] p<0.026). The only immune-related adverse events independently associated with steroid failure in myocarditis were myasthenia gravis-like syndrome (26.7% vs 8.2%, OR=3.84 [1.47–10.10] p=0.006) and myositis (45.0% vs 24.7%, OR=2.38 [1.16–4.92] p=0.018). Steroid failure was not significantly associated with cardiovascular or autoimmune history but was associated with a history of thymoma (12.0% vs 2.6%, OR=18.86 [0.10–356.7] p=0.05) Conclusion(s) Features such as female sex, high body mass index, and pre-existing thymoma as well as findings of elevated cardiac biomarkers and other non-cardiac immune-related adverse events – particularly myositis and myasthenia gravis-like syndrome – may represent a steroid-refractory phenotype of ICI-associated myocarditis. These results suggest that a multidisciplinary approach to diagnosing concomitant non-cardiac immune related adverse events is key to risk-stratifying ICI-associated myocarditis. Forrest Plot Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): National Institutes of Health

A multi-institutional retrospective analysis of immune checkpoint inhibitor efficacy in gynecologic cancers

2021 ◽  
Vol 162 ◽  
pp. S76-S77
Author(s):  
Rachael Acker ◽  
Amanda Ramos ◽  
Eric Eisenhauer ◽  
Richard Penson ◽  
Cesar Castro ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Gynecologic Cancers

Retrospective analysis of immune checkpoint inhibitor-associated myocarditis from 12 cancer centers in China.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e15130-e15130
Author(s):  
Feng Wang ◽  
Shukui Qin ◽  
Fang Lou ◽  
Feng Xiao Chen ◽  
Meiqi Shi ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Retrospective Analysis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Troponin I ◽  
Checkpoint Inhibitor ◽  
Cardiac Biomarkers ◽  
Chinese Patients ◽  
Cancer Centers ◽  
The Common

e15130 Background: Immune checkpoint inhibitor(ICI) -associated myocarditis is rare, but it could account for a very high mortality rate. This study reviewed the occurrence of ICI-associated myocarditis in Chinese cancer patients. Methods: A retrospective analysis was made on the occurrence of ICI-associated myocarditis in cancer centers of 12 3A-grade hospitals in China from January 1, 2018 to December 31, 2019. More than 100 patients were treated with ICIs in each center. Results: A total of 2373 patients were treated with ICI alone or in combination. The incidence of ICI-associated myocarditis was 1.05% (25/2373). Of all the data elicited from 16 patients in this study, the tumor types were listed, including: melanoma, lung cancer, renal cancer, urothelial cancer, liver cancer, gastric cancer, colorectal cancer, etc. The 16 patients included 8 male and 8 female with a median age of 65 (36-80). 3 of them had coronary heart disease. The ICI drugs included nivolumab, pembrolizumab and toripalimab, camrelizumab, sintilimab, tislelizumab, atezolizumab. Among them, there were 10 cases of PD-1 inhibitor, 1 case of PD-L1 inhibitor, 5 cases of PD-1 inhibitor combined with chemotherapy or molecular targeted drug. ICI-associated myocarditis occurred in a median of 38 days (2-420) after treatment during which 81.2% (13/16) of them received ICI 1-2 infusions. The common clinical symptoms were palpitation, chest distress and dyspnea, in addition to 8 cases with asthenia, 4 cases with respiratory failure, 2 cases without symptoms. ECG abnormality accounted for 87.5% (14/16). The common abnormalities included: 6 cases of atrial premature contraction, 4 cases of ventricular premature contraction, 3 cases of sinus tachycardia, 1 case of Grade 3 atrioventricular, 1 case of complete right bundle block, and 1 case of acute myocardial infarction. 15 cases of abnormal troponin I or T were observed, followed by CK, CK-MB, MYO and BNP increased. 14 patients were treated with glucocorticoid. 6 patients died with the mortality rate 37.5%(6/16) and 66.7% (4/6) were over 70 years old. Conclusions: The incidence of ICI-associated myocarditis in Chinese patients is low, but the mortality rate is high. Regular monitoring of cardiac biomarkers and ECG is helpful for early diagnosis.

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