Clinical implications of isolated troponinemia following immune checkpoint inhibitor therapy

D Delombaerde; D Vervloet; C Franssen; L Croes; F Gremonprez; H Prenen; M Peeters; C Vulsteke

doi:10.1016/j.esmoop.2021.100216

Clinical implications of isolated troponinemia following immune checkpoint inhibitor therapy

ESMO Open. 2021 Aug;6(4):100216. doi: 10.1016/j.esmoop.2021.100216. Epub 2021 Jul 13.

Authors

D Delombaerde¹, D Vervloet², C Franssen³, L Croes⁴, F Gremonprez⁵, H Prenen⁶, M Peeters⁶, C Vulsteke⁴

Affiliations

¹ Integrated Cancer Center Ghent, Department of Medical Oncology, AZ Maria Middelares, Ghent, Belgium; Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium. Electronic address: [email protected].
² Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
³ Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
⁴ Integrated Cancer Center Ghent, Department of Medical Oncology, AZ Maria Middelares, Ghent, Belgium; Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium.
⁵ Integrated Cancer Center Ghent, Department of Medical Oncology, AZ Maria Middelares, Ghent, Belgium.
⁶ Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium; Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, Edegem, Belgium.

Abstract

Cardiovascular adverse events induced by immune checkpoint inhibitors (ICIs) have gained significant interest over the past decade due to their impact on short- and long-term outcomes. They were initially thought to be rare, but the increasing use of ICIs in the treatment of both advanced and early stages of various malignancies has resulted in a substantial increase in their incidence. Different guidelines have proposed screening measures for ICI-induced myocarditis by incorporating troponin measurements at baseline and during the first few weeks of treatment. However, no specific guidelines have been developed yet regarding the interpretation of an asymptomatic rise in troponins. This state-of-the art review aims to provide an overview of the clinical relevance of elevated troponins during checkpoint inhibition and recommendations on how to manage elevated troponin levels during ICI therapy.

Keywords: biomarker; cancer; cardiac troponin; cardiotoxicity; immunotherapy; myocarditis.

Publication types

Review

MeSH terms

Cardiotoxicity / drug therapy
Humans
Immune Checkpoint Inhibitors
Myocarditis* / drug therapy
Neoplasms* / drug therapy
Troponin / therapeutic use

Substances

Immune Checkpoint Inhibitors
Troponin