Optimized monitoring for immune checkpoint inhibitor induced myocarditis using high-sensitivity troponin-T
Tomsitz D, Grabmaier U, Spiro J, Nicolai L, French LE, Massberg S, Heinzerling L (2025)
Publication Type: Journal article
Publication year: 2025
Journal
Book Volume: 216
Article Number: 115186
DOI: 10.1016/j.ejca.2024.115186
Abstract
Background: Immune checkpoint inhibitor (ICI)-induced Myocarditis (irMyocarditis) is a rare adverse event with a high mortality rate of 40–50 % and which is mostly not diagnosed until clinical symptoms emerge. Objectives: This study aims to screen patients for irMyocarditis using high-sensitivity cardiac troponin-T (hs-TnT) before and regularly during therapy with ICI. Methods: A cohort of 280 cancer patients were prospectively screened for levels of hs-TnT at baseline and prior to every ICI infusion. In case of elevation of hs-TnT, patients were referred for further work-up. Results: In total, 196 patients exhibited a baseline hs-TnT ≤ 14 ng/l (99th percentile concentration for general population; group A) and 84 patients a hs-TnT > 14 ng/l at baseline (group B). An increase of hs-TnT during ICI-treatment was observed in 56 out of 196 (27.6 %) and 56 out of 84 patients (66.7 %) in group A and B. Cardiovascular assessment was performed in 11.2 % and 27.4 % of patients, respectively, and 4.1 % and 9.5 % of patients were diagnosed with irMyocarditis and treated with corticosteroids. No fatalities occurred in any of the 16 irMyocarditis patients. Defining a threshold with the highest sensitivity and maximum specificity in receiver-operating characteristics curves, identified a limit of 22 ng/l (group A) and 60 ng/l (group B) hs-TnT, associated with a sensitivity of 100 % in both and a specificity of 91.0 % and 89.6 %, respectively, to detect irMyocarditis. Conclusion: Screening of hs-TnT can identify irMyocarditis early and lead to reduction of MACE and mortality risk through interruption of ICI-treatment and prompt therapy with corticosteroids.
Involved external institutions
Germany (DE)How to cite
APA:
Tomsitz, D., Grabmaier, U., Spiro, J., Nicolai, L., French, L.E., Massberg, S., & Heinzerling, L. (2025). Optimized monitoring for immune checkpoint inhibitor induced myocarditis using high-sensitivity troponin-T. European Journal of Cancer, 216. https://doi.org/10.1016/j.ejca.2024.115186
MLA:
Tomsitz, Dirk, et al. "Optimized monitoring for immune checkpoint inhibitor induced myocarditis using high-sensitivity troponin-T." European Journal of Cancer 216 (2025).
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