Review Article

Risk Factors for Immune Checkpoint Inhibitor–Related Myocarditis: An Integrative Review

Sara M. Otto, MS, APRN, FNP-BC, AOCNP®, Ashely L. Martinez, DNP, APRN, FNP-BC, AOCNP®, CBCN, CPHQ, NEA-BC, and Joyce E. Dains, DrPH, JD, APRN, FNP-BC, FNAP, FAANP, FAAN

From The University of Texas MD Anderson Cancer Center, Houston, Texas

Authors’ disclosures of conflicts of interest are found at the end of this article.

Correspondence to: Sara Otto, MS, APRN, FNP-BC, AOCNP®, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030 E-mail: smotto@mdanderson.org

ABSTRACT

Purpose: The purpose of this integrative literature review was to determine factors that increase the risk of immune checkpoint inhibitor (ICI)–related myocarditis in the cancer patient population. Methods: A literature review was conducted using the following databases: PubMed, Scopus, and Cochrane Review. Dates searched were from inception through March 1, 2022. Inclusion criteria included English language, cancer patients receiving ICI treatment, and risk factors for myocarditis. Articles were excluded if they were a non-human study, duplicate, had an irrelevant title or content, or were a review or commentary. Results: Patients with cancer who receive ICIs have an associated increased risk of myocarditis if they are older than 64 years, have a body mass index (BMI) greater than 28, and have a history of cardiovascular medication use. Conclusions: Myocarditis remains a rare cardiovascular adverse effect of ICIs. However, the mortality risk among this subset of patients remains high. Additional prospective randomized-controlled trials would be beneficial to further determine a causal relationship between risk factors for ICI-related myocarditis. Risk stratification tools may allow oncology medical providers to identify patients at a higher risk of ICI-related myocarditis to increase earlier surveillance.

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