Clinical characteristics, diagnosis and management of nivolumab-induced myocarditis: hypersensitivity myocarditis, or something else

In the important review published in Invest New Drugs [1] the authors examined the clinical features of myocarditis caused by nivolumab and offered support for clinical diagnosis, management, and prevention. They concluded that systemic corticosteroids along with immunoglobulins or immunosuppressants, along with plasmapheresis, could be a successful treatment in addition to immediately stopping nivolumab. However, out of the 66 patients, 35 patients ultimately died, with myocarditis being the cause of death in 68.6% of cases. However, 42 patients (63.6%) experienced remission after stopping nivolumab and receiving systemic corticosteroids, immunoglobulins, plasmapheresis, and immunosuppressive drugs within a median of 8 days. The pathophysiology of myocarditis in cancer patients caused by nivolumab is called into question by these findings. Nivolumab-treated cancer patients run the risk of developing two serious clinical pathologies. When the causing treatment is stopped, cardiotoxicity—a dose-dependent adverse effect on the heart—continues and can result in the fibrotic process. Conversely, cardiovascular hypersensitivity does not depend on drug dosage and can develop at any point while a patient is receiving treatment, even at very low doses. …