[Pubmed] Extracardiovascular immune-related adverse events in patients with suspected cardiac toxicity associated with i

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Rev Med Interne. 2026 Oct 16:S0248-8663(26)00701-0. doi: 10.1016/j.revmed.2026.08.008. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but may cause immune-related adverse events (iRAEs). Cardiovascular iRAEs, especially myocarditis, carry high morbidity and mortality. Extracardiovascular iRAEs are included as diagnostic criteria for myocarditis, yet their prevalence, spectrum, and clinical impact in patients with suspected cardiovascular iRAEs are poorly defined.

METHODS: We conducted a prospective, single-center observational study between March 2022 and December 2023. Consecutive patients referred to cardio-oncology for suspected ICI-related cardiovascular toxicity underwent systematic cardiovascular evaluation, internal medicine assessment, pharmacovigilance review, and multidisciplinary adjudication. Data included cardiovascular and extracardiovascular iRAEs, treatment decisions, and outcomes.

RESULTS: Among 208 patients enrolled (median age 60 years; 78% female), 206 completed follow-up. Cardiovascular iRAEs were confirmed in 108 patients, predominantly myocarditis (75%). Extracardiovascular iRAEs occurred in 32% of patients (n = 67; 97 events), most frequently endocrine (57.6%, mainly thyroid), followed by muscular and cutaneous events (each 9.3%). Most extracardiovascular iRAEs were CTCAE grade 2, while severe muscular or neurological toxicities, including myositis and myasthenia gravis, occurred in 1.4%. Myocarditis was more frequent in patients with extracardiovascular iRAEs (57% vs. 34%). In 18 cases, extracardiovascular iRAEs fulfilled IC-OS minor criteria, enabling a definite myocarditis diagnosis. ICIs were discontinued in 56% of patients, with extracardiovascular iRAEs contributing in 15%, and accounted for nearly one-third of indications for immunosuppressive therapy. Mortality was mainly cancer-related.

CONCLUSIONS: In patients referred for suspected ICI-related cardiovascular toxicity, extracardiovascular iRAEs are frequent and clinically relevant. They contribute to myocarditis diagnosis and management, supporting systematic multidisciplinary cardiology-internal medicine evaluation.

PMID:42888061 | DOI:10.1016/j.revmed.2026.08.008


Source: https://pubmed.ncbi.nlm.nih.gov/4288806 ... 8&v=2.20.1