Immune checkpoint inhibitors-associated myocarditis in 7 patients with bladder cancer
10.3969/j.issn.1009-8291.2025.10.006
- VernacularTitle:免疫检查点抑制剂治疗膀胱癌相关免疫性心肌炎7例分析
- Author:
Rongjie BAI
1
;
Xiao YANG
1
;
Hao YU
1
;
Lingkai CAI
1
;
Chenghao WANG
1
;
Qiang CAO
1
;
Qiang LYU
1
Author Information
1. 南京医科大学第一附属医院,江苏省人民医院泌尿外科,江苏南京 210029
- Publication Type:Journal Article
- Keywords:
bladder cancer;
immune checkpoint inhibitors;
immune myocarditis;
methylprednisolone;
immune globulin;
infliximab;
tofacitinib;
respiratory failure
- From:
Journal of Modern Urology
2025;30(10):848-853
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical characteristics and treatment of immune checkpoint inhibitors(ICIs)-associated myocarditis in patients with bladder cancer(BCa).Methods Clinical and follow-up data of 213 BCa patients treated with ICIs in our hospital during Jan.2020 and May 2024 were collected.The data of 7 patients(3.3％)who developed ICIs-associated myocarditis were analyzed.Results The cohort included 2 females and 5 males(median age:72 years).Four patients were asymptomatic,while 3 presented with chest tightness,dyspnea,or orthopnea.All patients showed significantly elevated high-sensitivity troponin T.Only 2 patients had markedly increased N-terminal pro-B-type natriuretic peptide.Electrocardiograms were normal in 4 patients,while 2 patients exhibited significantly reduced left ventricular global longitudinal strain on echocardiography,with cardiac magnetic resonance confirming acute myocarditis.All patients discontinued ICIs and received first-line methylprednisolone upon diagnosis.Two patients showed no improvement after 5 days of treatment and received second-line therapy.One patient received intravenous immunoglobulin and infliximab without response,but improved after third-line tofacitinib.One patient developed acute respiratory failure after intravenous immunoglobulin administration and was then transferred to ICU,and died of multiple organ failure after 10 days.Conclusion ICIs-associated myocarditis is a relatively rare but clinically distinct immune-related adverse reaction during BCa treatment.Methylprednisolone is the first-line therapy,while critically ill and steroid-resistant patients often require early combined immunosuppressants based on individualized multidisciplinary discussion.
