Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review

Timothy Barry; Rory Gallen; Catherine Freeman; Pradyumna Agasthi; Dawn Pedrotty; Ming Yang; Clinton E. Jokerst; Farouk Mookadam; Brian W. Hardaway; Lisa LeMond; Reza Arsanjani; Carolyn Larsen

doi:10.1016/j.amjms.2021.04.018

Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review

Timothy Barry, Rory Gallen, Catherine Freeman, Pradyumna Agasthi, Dawn Pedrotty, Ming Yang, Clinton E. Jokerst, Farouk Mookadam, Brian W. Hardaway, Lisa LeMond, Reza Arsanjani, Carolyn Larsen

Research output: Contribution to journal › Review article › peer-review

Abstract

Immune checkpoint inhibitor (ICI) monoclonal antibody drugs are an important interface of immunology and cancer biology with the intended goal to create cancer specific treatments with less systemic toxicity. Recognition of immune-related adverse events is critical and these include significant cardiovascular toxicity and myocarditis. Compared with other immune-related events, ICI associated myocarditis is rare but is associated with high mortality. The majority of cases present early in the course of therapy and patients can rapidly progress to fulminant myocarditis. Initially, the mainstay of treatment in patients with ICI-associated myocarditis is immunosuppressive therapy with glucocorticoids. For those who do not respond to steroids, the optimal treatment is unclear. This review summarizes the potential adjunctive treatment options for patients with steroid-refractory myocarditis by illustrating a case of myocarditis that was treated with Thymoglobulin and immunoglobulin.

Original language	English (US)
Pages (from-to)	424-432
Number of pages	9
Journal	American Journal of the Medical Sciences
Volume	362
Issue number	4
DOIs	https://doi.org/10.1016/j.amjms.2021.04.018
State	Published - Oct 2021

Keywords

Thymoglobulin
cardiotoxicity
immune checkpoint inhibitor
immunoglobulin
myocarditis

ASJC Scopus subject areas

General Medicine

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10.1016/j.amjms.2021.04.018

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Barry, T., Gallen, R., Freeman, C., Agasthi, P., Pedrotty, D., Yang, M., Jokerst, C. E., Mookadam, F., Hardaway, B. W., LeMond, L., Arsanjani, R., & Larsen, C. (2021). Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review. American Journal of the Medical Sciences, 362(4), 424-432. https://doi.org/10.1016/j.amjms.2021.04.018

Barry, T, Gallen, R, Freeman, C, Agasthi, P, Pedrotty, D, Yang, M, Jokerst, CE, Mookadam, F, Hardaway, BW, LeMond, L, Arsanjani, R & Larsen, C 2021, 'Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review', American Journal of the Medical Sciences, vol. 362, no. 4, pp. 424-432. https://doi.org/10.1016/j.amjms.2021.04.018

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abstract = "Immune checkpoint inhibitor (ICI) monoclonal antibody drugs are an important interface of immunology and cancer biology with the intended goal to create cancer specific treatments with less systemic toxicity. Recognition of immune-related adverse events is critical and these include significant cardiovascular toxicity and myocarditis. Compared with other immune-related events, ICI associated myocarditis is rare but is associated with high mortality. The majority of cases present early in the course of therapy and patients can rapidly progress to fulminant myocarditis. Initially, the mainstay of treatment in patients with ICI-associated myocarditis is immunosuppressive therapy with glucocorticoids. For those who do not respond to steroids, the optimal treatment is unclear. This review summarizes the potential adjunctive treatment options for patients with steroid-refractory myocarditis by illustrating a case of myocarditis that was treated with Thymoglobulin and immunoglobulin.",

keywords = "Thymoglobulin, cardiotoxicity, immune checkpoint inhibitor, immunoglobulin, myocarditis",

author = "Timothy Barry and Rory Gallen and Catherine Freeman and Pradyumna Agasthi and Dawn Pedrotty and Ming Yang and Jokerst, {Clinton E.} and Farouk Mookadam and Hardaway, {Brian W.} and Lisa LeMond and Reza Arsanjani and Carolyn Larsen",

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year = "2021",

month = oct,

doi = "10.1016/j.amjms.2021.04.018",

language = "English (US)",

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AU - Agasthi, Pradyumna

AU - Pedrotty, Dawn

AU - Yang, Ming

AU - Jokerst, Clinton E.

AU - Mookadam, Farouk

AU - Hardaway, Brian W.

AU - LeMond, Lisa

AU - Arsanjani, Reza

AU - Larsen, Carolyn

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AB - Immune checkpoint inhibitor (ICI) monoclonal antibody drugs are an important interface of immunology and cancer biology with the intended goal to create cancer specific treatments with less systemic toxicity. Recognition of immune-related adverse events is critical and these include significant cardiovascular toxicity and myocarditis. Compared with other immune-related events, ICI associated myocarditis is rare but is associated with high mortality. The majority of cases present early in the course of therapy and patients can rapidly progress to fulminant myocarditis. Initially, the mainstay of treatment in patients with ICI-associated myocarditis is immunosuppressive therapy with glucocorticoids. For those who do not respond to steroids, the optimal treatment is unclear. This review summarizes the potential adjunctive treatment options for patients with steroid-refractory myocarditis by illustrating a case of myocarditis that was treated with Thymoglobulin and immunoglobulin.

KW - Thymoglobulin

KW - cardiotoxicity

KW - immune checkpoint inhibitor

KW - immunoglobulin

KW - myocarditis

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Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review

Abstract

Keywords

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