{"doi":"10.1136/jitc-2021-002553","title":"Clinical characteristics, time course, treatment and outcomes of patients with immune checkpoint inhibitor-associated myocarditis","abstract":"BACKGROUND: Immune checkpoint inhibitors (ICI) have emerged as a front-line therapy for a variety of solid tumors. With the widespread use of these agents, immune-associated toxicities are increasingly being recognized, including fatal myocarditis. There are limited data on the outcomes and prognostic utility of biomarkers associated with ICI-associated myocarditis. Our objective was to examine the associations between clinical biomarkers of cardiomyocyte damage and mortality in patients with cancer treated with ICIs. METHODS: We retrospectively studied 23 patients who developed symptomatic and asymptomatic troponin elevations while receiving ICI therapy at a National Cancer Institute-designated comprehensive cancer center. We obtained serial ECGs, troponin I, and creatine kinase-MD (CK-MB), in addition to other conventional clinical biomarkers, and compared covariates between survivors and non-survivors. RESULTS: Among patients with myocarditis, higher troponin I (p=0.037) and CK-MB (p=0.034) levels on presentation correlated with progression to severe myocarditis. Higher troponin I (p=0.016), CK (p=0.013), and CK-MB (p=0.034) levels were associated with increased mortality, while the presence of advanced atrioventricular block on presentation (p=0.088) trended toward increased mortality. Weekly troponin monitoring lead to earlier hospitalization for potential myocarditis (p=0.022) and was associated with decreased time to steroid initiation (p=0.053) and improved outcomes. CONCLUSIONS: Routine troponin surveillance may be helpful in predicting mortality in ICI-treated patients with cancer in the early phase of ICI therapy initiation. Early detection of troponin elevation is associated with earlier intervention and improved outcomes in ICI-associated myocarditis. The recommended assessment and diagnostic studies guiding treatment decisions are presented.","journal":"Journal for ImmunoTherapy of Cancer","year":2021,"id":153734,"datarank":0.637274286307404,"base_score":4.248495242049359,"endowment":4.248495242049359,"self_citation_contribution":0.637274286307404,"citation_network_contribution":0.0,"self_endowment_contribution":0.637274286307404,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":69,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9572,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":651838,"name":"Poornima Subramanian","orcid":"0000-0002-6449-6549","position":1,"is_corresponding":false},{"id":651839,"name":"Yan Yatsynovich","orcid":"0000-0001-8463-8017","position":2,"is_corresponding":false},{"id":351344,"name":"David M. Jacobs","orcid":"0000-0001-9240-7067","position":3,"is_corresponding":false},{"id":651840,"name":"Maya R. Chilbert","orcid":"0000-0003-3183-5214","position":4,"is_corresponding":false},{"id":406217,"name":"Umesh C. Sharma","orcid":"0000-0003-0476-2523","position":5,"is_corresponding":false},{"id":264672,"name":"Fumito Ito","orcid":"0000-0002-6866-671X","position":6,"is_corresponding":false},{"id":652691,"name":"Steven Feuerstein","orcid":null,"position":7,"is_corresponding":false},{"id":652692,"name":"Filip Stefanovic","orcid":"0000-0002-1448-9578","position":8,"is_corresponding":false},{"id":651841,"name":"Benjamin Switzer","orcid":"0000-0001-8150-1963","position":9,"is_corresponding":false},{"id":651842,"name":"Mark D. Hicar","orcid":"0000-0002-1768-5419","position":10,"is_corresponding":false},{"id":351764,"name":"Anne B. Curtis","orcid":"0000-0002-9115-8051","position":11,"is_corresponding":false},{"id":652693,"name":"Edward Spangenthal","orcid":null,"position":12,"is_corresponding":false},{"id":368989,"name":"Grace K. Dy","orcid":"0000-0002-5061-0072","position":13,"is_corresponding":false},{"id":260460,"name":"Marc S. Ernstoff","orcid":"0000-0002-8132-7069","position":14,"is_corresponding":false},{"id":268512,"name":"Pankit Vachhani","orcid":"0000-0001-9779-6217","position":15,"is_corresponding":false},{"id":651843,"name":"Brian Page","orcid":"0000-0002-8945-568X","position":16,"is_corresponding":false},{"id":651844,"name":"Nikhil Agrawal","orcid":"0000-0002-5365-6332","position":17,"is_corresponding":false},{"id":652694,"name":"Arjun Khunger","orcid":null,"position":18,"is_corresponding":false},{"id":651845,"name":"Ankita Kapoor","orcid":"0000-0002-6600-6726","position":19,"is_corresponding":false},{"id":652695,"name":"Alexander Hattoum","orcid":null,"position":20,"is_corresponding":false},{"id":651846,"name":"Jerome J. Schentag","orcid":"0009-0009-1107-8691","position":21,"is_corresponding":false},{"id":258834,"name":"Igor Puzanov","orcid":"0000-0002-9803-3497","position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:43:44.759273Z","pmid":"34162715","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}