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Yue-Li Sun



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    P26 - Mesothelioma, Thymoma and Other Thoracic Malignancies - Thymic Malignancies (ID 218)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P26.06 - High frequency of Fatal Immune Checkpoint Inhibitor Associated Myocarditis in B2/B3 Thymoma Patients (ID 2189)

      00:00 - 00:00  |  Presenting Author(s): Yue-Li Sun

      • Abstract
      • Slides

      Introduction

      Myocarditis, the incidence was around 0.09%, is uncommon adverse event of immune checkpoint inhibitors (ICI), but is often serious with a relatively high mortality. However, the incidence of myocarditis was reported much higher in thymic epithelial tumor patients treated with immunotherapy, which was 5%-9%. Myocarditis after ICI in thymic epithelial tumor has not been well characterized.

      Methods

      We retrospectively analyzed patients diagnosed with myocarditis after ICI in thymic epithelial tumor in our hospital from January 2016 to July 2019. The main outcomes were clinical manifestations. We also searched on Pubmed database up until 03/13/2020 with the following search terms: myocarditis, thymoma, checkpoint, or check point. Case reports on myocarditis caused by immune checkpoint inhibitors were selected.

      Results

      There were 301 patient diagnosed with thymic epithelial tumor in our hospital from January 2016 to July 2019. Eight patients treated with immune checkpoint inhibitors were included. Four patients developed myocarditis during pembrolizumab treatment, 1 patient during sintilimab. Median age was 48 (range 27-56) years. Two of them were male. Median time of onset of myocarditis was 12 days after starting ICI treatment (range 8-63 days). All of them were B1/B2/B3 thymoma subtype. In all patients, the concentrations of brain natriuretic peptide (BNP) and troponin increased obviously. Three of them died within 11 days after developed myocarditis. All of these 3 patients, troponin was more than 6000pg/ml and electrocardiogram showed ventricular arrhythmia. Only 1 patient had response to high-dose steroid treatment. Seven cases citing myocarditis as a side effect of ICI treatment in thymic epithelial tumor patients were identified by searching on Pubmed. All of them were B2/B3 thymoma subtype. Six of them received pembrolizumab treatment, and 1 patient received Nivolumab. Myocarditis occurred just after first dose of ICI therapy in 4 patients. The other two patients were developed myocarditis on the second cycle.

      Conclusion

      Myocarditis may be more common than appreciated in B2/B3 thymoma patients treated with ICI treatment, especially with pembrolizumab, and it occurs early after starting ICI treatment. Further researches should be established in dealing or predicting with this potentially fatal side effect.

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