Students Research in Progress
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Introduction:
Immune checkpoint inhibitors (ICIs) have been associated with various cardiovascular toxicities including myocarditis and myopericarditis. While an international registry has provided an understanding of characteristics of ICI-induced myocarditis, appropriate management remains unclear.
Research Question or Hypothesis: The objective of our case series is to understand current management practices and associated outcomes of ICI-induced myocarditis and myopericarditis.
Study Design: This was a retrospective, single-center case series.
Methods: Following Institutional Review Board approval, five patients receiving an ICI with an ICD-9/-10 code for myocarditis or myopericarditis from April 1, 2014 to June 15, 2024 were identified. Patients were excluded if age <18 years, pregnancy, or cardiotoxic events preceding ICI administration. Clinical characteristics, myocarditis/myopericarditis and cancer management, and outcomes were collected. REDCap was utilized for data collection and descriptive analysis.
Results: To date, data on five cases with documented ICI-associated myocarditis (n=3) and myopericarditis (n=2) are available. Median age was 68 years (range: 40-89), 60% female, 80% white, 20% black and all non-Hispanic. Cancer types varied (two lung cancer, two urothelial cancer, one laryngeal cancer). ICIs administered included pembrolizumab (n=3), nivolumab (n=1) or avelumab (n=1). Median time to onset from ICI initiation was 29 days (range: 25-42) for myocarditis and 40 days (23 and 56) for myopericarditis. All patients initially received corticosteroids (methylprednisolone, n=2; prednisone, n=3); mean time to first dose was one day (range: 0-3). One patient with myocarditis received a nonsteroidal anti-inflammatory agent. Three patients had alternative cancer therapy initiated with a mean delay of 35 days (range: 34-36), one patient was transitioned to comfort care, and the other patient had treatment held indefinitely without data on care transition.
Conclusion: Additional cases will provide a better understanding of ICI-induced myocarditis and myopericardits management strategies and all cases will be contributed to the existing international registry.
Presenting Author
Hannah Summers PharmD CandidateUniversity of North Carolina at Chapel Hill
Authors
Sarah Kaspari PharmD
UNC Eshelman School of Pharmacy
Chloe Kim PharmD
University of North Carolina at Chapel Hill
Emily Ong PharmD Candidate
University of North Carolina at Chapel Hill
Christian Palumbo PharmD Candidate
University of North Carolina at Chapel Hill
Kristina Paramore PharmD, MPH
UNC Eshelman School of Pharmacy
Kaitlyn Paxton PharmD, MBA
UNC Eshelman School of Pharmacy
Jo E. Rodgers PharmD, FCCP, BCPS-AQ Cardiology
Eshelman School of Pharmacy, University of North Carolina
Zijie Zhang PharmD Candidate
University of North Carolina at Chapel Hill