Table 3.
Description of myocarditis cases.
| 1st patient | 2nd patient | 3rd patient | |
|---|---|---|---|
| Primary cancer type | Squamous cell carcinoma | Adenocarcinoma | Small cell lung cancer |
| ICI regimens | Atezolizumab | Pembrolizumab | Atezolizumab |
| Single agent or combined | Monotherapy | Combinaison | Combinaison |
| Line of treatment | 2nd line | 1st line | 1st line |
| Pre-existing auto-immune diseases | No | No | No |
| Other immune side effects during treatment | No | Dermatitis (grade I) | no |
| Time from first administration to myocarditis (days) | 147 | 147 | 141 |
| Biomarkers | |||
| Serum troponin (ng/l) standard <15,6 (ng/l) | 75 | 20,8 | 202 |
| BNP (pg/ml) | 13 | 21 | 45 |
| CPK (UI/l) | 38 | 57 | 33 |
| ECG | |||
| Sinus rythm | Yes | Yes | Yes |
| PR (ms) | 160 | 178 | 160 |
| QRS (ms) | 100 | 96 | 80 |
| TTE | |||
| LVEF(%) | 53 | 61 | 65 |
| Strain(%) | −19.5 | Not performed | Not performed |
| S'VD (cm/s) | 11.5 | Not performed | Not performed |
| Cardiac-MRI | |||
| Edema by T2 | Yes | No | Yes |
| Late Gadolinium enhancement | Yes | No | Yes |
| Coronary angiography | negative | Negative | Negative |
| Endomyocardial biopsy | Non specific edema | Not performed | Not performed |
| Final diagnosis | Definite myocarditis | Possible myocarditis | Definite myocarditis |
| ICI rechallenge | |||
| Yes/no | yes | Yes | No |
| ICI regimen | Nivolumab | Pembrolizumab | - |
| Time to rechallenge (in days) | 124 | 71 | - |
| Recurrence yes/no | No | Yes | - |
ECG, electrocardiogram; ICI, Immune checkpoint inhibitors; TTE, Transthoracic echocardiogram; LVEG, Left ventricular ejection fraction; Cardiac-MRI, Cardiac Magnetic Resonance Imaging.