Cardiotoxicity of immunotherapy in lung cancer in light of new ESC guidelines

• Authors: Gabriela B. Orzeł , Maciej Łydka , Justyna Lewandowska , Julia Stachowiak , Ewelina Szymańska , Katarzyna Mizia-Stec

Title variants

PL

Kardiotoksyczność immunoterapii w raku płuca w świetle nowych wytycznych ESC

• Languages of publication: EN PL

Abstracts

EN

There has been rapid development of anticancer therapies involving monoclonal antibodies targeting immune checkpoints of the immune response. One of them is pembrolizumab (the anti-programmed death receptor 1 ligand – anti-PD-1) used in the treatment of malignant melanoma, non-small cell lung cancer, or triple-negative breast cancer, among others. The case presented in this paper refers to a patient suffering from adenocarcinoma of the lung with multiple metastases and associated diseases. During immunotherapy with pembrolizumab, acute myocarditis was diagnosed. The clinical course of this case study specifically demonstrates how important, in the context of oncology patients treated with immunotherapy, the continuous evaluation and control are of the occurrence of adverse toxic effects associated with anticancer treatment. First of all, potential PD-1 inhibitor cardiotoxicity is rare in patients undergoing therapy with this drug, which significantly hinders accurate differential diagnosis in this direction. Second, this adverse effect, although relatively rare, is often fatal. The following case study describes how, with high doses of glucocorticosteroids, the effects of pembrolizumab-induced toxicity can be effectively muted.

PL

Obserwuje się dynamiczny rozwój terapii przeciwnowotworowej z udziałem przeciwciał monoklonalnych ukie-runkowanych na odpornościowe punkty kontroli odpowiedzi immunologicznej. Jednym z nich jest pembroli-zumab (humanizowane przeciwciało skierowane przeciwko receptorowi programowanej śmierci komórki 1 – anty-PD-1), stosowany w leczeniu m.in. czerniaka złośliwego, niedrobnokomórkowego raka płuc czy potrójnie ujemnego raka piersi. Przedstawiony w niniejszej pracy przypadek kliniczny dotyczy pacjenta chorującego na raka gruczołowego płuca z licznymi przerzutami oraz chorobami towarzyszącymi. W trakcie immunoterapii pembrolizumabem rozpoznano ostre zapalenie mięśnia sercowego. Przebieg kliniczny tej choroby w sposób szczególny wskazuje na to, jak istotna u pacjentów onkologicznych leczonych immunoterapią jest ciągła oce-na i kontrolowanie niepożądanych efektów toksycznych związanych z leczeniem przeciwnowotworowym. Po pierwsze, potencjalna kardiotoksyczność inhibitora PD-1 występuje rzadko u pacjentów poddanych terapii tym lekiem, co znacznie utrudnia precyzyjną diagnostykę różnicową w tym kierunku. Po drugie, ten niepożądany efekt, choć występuje stosunkowo rzadko, często jest śmiertelny. Opisany przypadek wskazuje, w jaki sposób za pomocą wysokich dawek glikokortykosteroidów można skutecznie wyciszać efekty toksyczności wywołanej przez pembrolizumab.

Keywords

EN

acute myocarditis; cardiovascular toxicity; immune inhibitors; inhibitory immunologiczne; ostre zapalenie mięśnia sercowego; pembrolizumab; toksyczność sercowo-naczyniowa

Discipline

• MEDICINE: MEDICINE

• Publisher: Śląski Uniwersytet Medyczny w Katowicach
• Journal: Annales Academiae Medicae Silesiensis
• Year: 2023
• Issue: 77
• Pages: 137–145

Contributors

author

Gabriela B. Orzeł

• 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland

author

Maciej Łydka

• Students’ Scientific Club, 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland

author

Justyna Lewandowska

• Students’ Scientific Club, 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland

author

Julia Stachowiak

• Students’ Scientific Club, 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland

author

Ewelina Szymańska

• 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland

author

Katarzyna Mizia-Stec

• 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland

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• Document Type: article