Approaches to Diagnosing and Managing Myocarditis Related to Immunotherapy

This is a video synopsis/summary of an OncLive Insights involving Afreen Shariff, MD, MBBS; Javid Moslehi, MD; and Nikhil Khushalani, MD.

To evaluate suspected immune checkpoint inhibitor (ICI) myocarditis, Dr Moslehi recommends a thorough history/physical, EKG, cardiac biomarkers like troponin and creatinine kinase, and echocardiogram, though ejection fraction may be normal. Further workup includes cardiac MRI, myocardial biopsy, and angiography to rule out heart attack. He advises admitting under telemetry monitoring and early cardiology involvement.

Regarding treatment, Dr Moslehi states steroids are commonly used in the first line, though optimal dosing remains unclear. Other immunosuppressive agents like the T-cell inhibitor abatacept and Janus kinase inhibitor ruxolitinib have shown mortality benefit in small studies and may precision-target myocardial inflammation pathways. However, controlled trials are still needed.

Dr Khushalani summarizes the key takeaways as having high suspicion for myocarditis, getting specialized cardiac diagnostics quickly, using high-dose steroids, and considering newer precision immunotherapy approaches.

Video synopsis is AI-generated and reviewed by OncLive^® editorial staff.