Journal-based CME Course: Clinical Strategy for the Diagnosis and Treatment of Immune Checkpoint InhibitorAssociated MyocarditisA Narrative ReviewClinical Strategy for the Diagnosis and Treatment of Immune Checkpoint Inhibitor MyocarditisClinical Strategy for the Diagnosis and Treatment of Immune Checkpoint Inhibitor Myocarditis

Activity ID

11953

Expires

November 8, 2024

Format Type

Journal-based

CME Credit

1

Fee

$30

CME Provider: JAMA Cardiology

Description of CME Course

In the last decade, immune checkpoint inhibitors (ICIs) have been approved for the treatment of many cancer types. Immune checkpoint inhibitorassociated myocarditis has emerged as a significant and potentially fatal adverse effect. Recognizing, diagnosing, and treating ICI-associated myocarditis poses new challenges for the practicing clinician. Here, the current literature on ICI-associated myocarditis is reviewed.

Clinical presentation and cardiac pathological findings are highly variable in patients with ICI-associated myocarditis. Although endomyocardial biopsy is the criterion standard diagnostic test, a combination of clinical suspicion, cardiac biomarkers (specifically troponin), and cardiac imaging, in addition to biopsy, is often needed to support the diagnosis. Importantly, the combination of a cytotoxic T-lymphocyteassociated protein 4 inhibitor with a programmed cell death protein 1 or programmed death-ligand 1 inhibitor increases the risk of developing ICI-associated myocarditis.

This review aims to provide a standardized diagnostic and therapeutic approach for patients with suspected ICI-associated myocarditis. A complete history of recent cancer treatments and physical examination in combination with cardiac biomarkers, cardiac imaging, and endomyocardial biopsy represent a pragmatic diagnostic approach for most cases of ICI-associated myocarditis. The addition of novel biomarkers or imaging modalities is an area of active research and should be evaluated in larger cohorts.

Disclaimers

1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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