优化免疫检查点抑制剂相关心肌炎的治疗：挑战、创新与再挑战考量
Refining the treatment of immune checkpoint inhibitor-associated myocarditis: Challenges, innovations and rechallenge considerations.
摘要(中文译文)
免疫检查点抑制剂（ICI）相关心肌炎已成为一种严重且临床复杂的免疫相关毒性，给常规心脏肿瘤学诊疗中的治疗决策带来了重大挑战。大剂量糖皮质激素仍是一线治疗，但其用药时机、剂量及减量方案需要审慎的临床判断。早期启动治疗可显著改善预后，但激素抵抗或延迟反应较为常见，需要升级至二线和三线免疫抑制治疗或挽救性治疗。现有挽救性治疗手段异质性较大，包括霉酚酸酯、阿巴西普、JAK抑制剂、血浆置换及其他靶向药物，这造成了显著的不确定性，因为证据大多局限于病例报告和小型病例系列。ICI诱导心肌炎的管理需要在免疫抑制与肿瘤控制之间取得平衡，尤其是在考虑再次挑战治疗时。预后的不确定性和有限的长期数据要求采取多学科、风险适配的诊疗模式，同时迫切需要强有力的前瞻性证据和标准化流程。本综述总结了ICI诱导心肌炎的当前管理策略，涵盖早期高强度糖皮质激素治疗、暴发性疾病的处理以及二线、三线和挽救性免疫抑制药物的使用。同时探讨了关键临床挑战，包括激素抵抗、抗肿瘤疗效的维持、ICI再次挑战治疗以及新兴的生物标志物驱动和转化医学方法，以支持个体化诊疗。
Abstract
Immune checkpoint inhibitor (ICI)-associated myocarditis has emerged as a severe and clinically complex immune-related toxicity that poses significant challenges for therapeutic decision-making in routine cardio-oncological care. High-dose corticosteroids remain the first-line therapy, yet their timing, dosage and tapering require careful clinical judgement. Early initiation substantially improves outcomes, but steroid resistance or delayed response is common and necessitates escalation to second- and third-line immunosuppression or rescue therapies. The heterogeneity of available rescue therapies, including mycophenolate mofetil, abatacept, JAK inhibitors, plasmapheresis and other targeted agents, creates significant uncertainty, because evidence is largely limited to case reports and small case series. Management of ICI-induced myocarditis requires balancing immunosuppression with cancer control, particularly when considering rechallenge. Prognostic uncertainty and limited long-term data necessitate multidisciplinary, risk-adapted care, while robust prospective evidence and standardised algorithms remain urgently needed. This review summarises current management strategies for ICI-induced myocarditis, encompassing early high-intensity corticosteroid therapy, treatment of fulminant disease, and the use of second- and third-line and rescue immunosuppressive agents. Key clinical challenges, including steroid resistance, preservation of antitumour efficacy, ICI rechallenge, and emerging biomarker-driven and translational approaches, are also addressed to support individualised care.
如何引用
AMA
Raluca I Mincu, Lisa Zimmer, Dimitra Vlachopoulou, Elias Haj-Yehia, Julia Hoffmann, Lars Michel, et al. Refining the treatment of immune checkpoint inhibitor-associated myocarditis: Challenges, innovations and rechallenge considerations.. British journal of pharmacology. 2026; doi:10.1111/bph.70536.
APA
Raluca I Mincu, Lisa Zimmer, Dimitra Vlachopoulou, Elias Haj-Yehia, Julia Hoffmann, Lars Michel, et al (2026). Refining the treatment of immune checkpoint inhibitor-associated myocarditis: Challenges, innovations and rechallenge considerations.. British journal of pharmacology. https://doi.org/10.1111/bph.70536
GB/T 7714
Raluca I Mincu, Lisa Zimmer, Dimitra Vlachopoulou, Elias Haj-Yehia, Julia Hoffmann, Lars Michel, et al. Refining the treatment of immune checkpoint inhibitor-associated myocarditis: Challenges, innovations and rechallenge considerations.[J]. British journal of pharmacology, 2026 doi:10.1111/bph.70536.
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