Myocarditis in the Setting of Cancer Therapeutics Proposed Case Definitions for Emerging Clinical Syndromes in Cardio-Oncology

Bonaca MP, Olenchock BA, Salem JE, Wiviott SD, Ederhy S, Cohen A, Stewart GC, Choueiri TK, Di Carli M, Allenbach Y, Kumbhani DJ, Heinzerling L, Amiri-Kordestani L, Lyon AR, Thavendiranathan P, Padera R, Lichtman A, Liu PP, Johnson DB, Moslehi J (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Circulation American Heart Association

Book Volume: 140

Pages Range: 80-91

Journal Issue: 1

DOI: 10.1161/CIRCULATIONAHA.118.034497

Abstract

Recent developments in cancer therapeutics have improved outcomes but have also been associated with cardiovascular complications. Therapies harnessing the immune system have been associated with an immune-mediated myocardial injury described as myocarditis. Immune checkpoint inhibitors are one such therapy with an increasing number of case and cohort reports describing a clinical syndrome of immune checkpoint inhibitor-associated myocarditis. Although the full spectrum of immune checkpoint inhibitor-associated cardiovascular disease still needs to be fully defined, described cases of myocarditis range from syndromes with mild signs and symptoms to fatal events. These observations in the clinical setting stand in contrast to outcomes from randomized clinical trials in which myocarditis is a rare event that is investigator reported and lacking in a specific case definition. The complexities associated with diagnosis, as well as the heterogeneous clinical presentation of immune checkpoint inhibitor-associated myocarditis, have made ascertainment and identification of myocarditis with high specificity challenging in clinical trials and other data sets, limiting the ability to better understand the incidence, outcomes, and predictors of these rare events. Therefore, establishing a uniform definition of myocarditis for application in clinical trials of cancer immunotherapies will enable greater understanding of these events. We propose an operational definition of cancer therapy-associated myocarditis that may facilitate case ascertainment and report and therefore may enhance the understanding of the incidence, outcomes, and risk factors of this novel clinical syndrome.

Authors with CRIS profile

Lucie Heinzerling Department of Dermatology

Involved external institutions

University of Toronto CA Canada (CA) Harvard University US United States (USA) (US) Assistance Publique-Hôpitaux de Paris (AP-HP) FR France (FR) Vanderbilt University US United States (USA) (US) University of Ottawa CA Canada (CA) Food and Drug Administration (FDA / USFDA) US United States (USA) (US) University of Texas Southwestern Medical Center (UT Southwestern) US United States (USA) (US) University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne FR France (FR) Dana–Farber Cancer Institute US United States (USA) (US) Royal Brompton Hospital GB United Kingdom (GB)

How to cite

APA:

Bonaca, M.P., Olenchock, B.A., Salem, J.-E., Wiviott, S.D., Ederhy, S., Cohen, A.,... Moslehi, J. (2019). Myocarditis in the Setting of Cancer Therapeutics Proposed Case Definitions for Emerging Clinical Syndromes in Cardio-Oncology. Circulation, 140(1), 80-91. https://dx.doi.org/10.1161/CIRCULATIONAHA.118.034497

MLA:

Bonaca, Marc P., et al. "Myocarditis in the Setting of Cancer Therapeutics Proposed Case Definitions for Emerging Clinical Syndromes in Cardio-Oncology." Circulation 140.1 (2019): 80-91.

BibTeX: Download