ArticleCardio-oncology (London, England)2020
Severe combined cardiac and neuromuscular toxicity from immune checkpoint blockade: an institutional case series.
Article in Cardio-oncology (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 4 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Triple-M syndrome after immune checkpoint inhibitors: a systematic review of cases-early recognition is critical to survival.Frontiers in neurology · 2026Pooled it
- Immune checkpoint inhibitor-associated myocarditis: a systematic analysis of case reports.Frontiers in immunology · 2023Pooled it
- Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: A Systematic Review.International journal of molecular sciences · 2022Pooled it
- Immune Checkpoint Inhibitor-Induced Myocarditis with Myositis/Myasthenia Gravis Overlap Syndrome: A Systematic Review of Cases.The oncologist · 2021Pooled it
- Triple-M Overlap Syndrome Associated with Immune Checkpoint Inhibitors: A FAERS Pharmacovigilance Analysis.Healthcare (Basel, Switzerland) · 2026Article
- Immune Checkpoint Inhibitor Therapy and Acute Coronary Syndrome: A Review of Mechanisms and Management.Journal of the American Heart Association · 2026Review
- Case Report and literature review: immune checkpoint inhibitor-associated myasthenia gravis and myocarditis.Frontiers in cardiovascular medicine · 2026Article
- Case Report: Immune checkpoint inhibitor-induced myositis/myocarditis with myasthenia gravis-like symptoms in a colon cancer patient with suspected thymic metastasis.Frontiers in oncology · 2026Article
- Myocarditis induced by a novel bifunctional PD-1/CTLA-4 combination antibody: a case report and literature review.BMC cardiovascular disorders · 2025Review
- Efgartigimod for immune checkpoint inhibitor induced polyradiculoneuropathy and cardiomyopathy: A case report.Experimental and therapeutic medicine · 2025Article
- A Rare Case of Overlapping Durvalumab-induced Myositis, Takotsubo-like Morphological Changes Caused by Myocarditis, and Myasthenia Gravis.Internal medicine (Tokyo, Japan) · 2024Article
- Steroid-Refractory Myocarditis Induced by Immune Checkpoint Inhibitor Responded to Infliximab: Report of Two Cases and Literature Review.Cardiovascular toxicology · 2024Review
- Myocarditis, Myositis, and Myasthenia Gravis Overlap Syndrome Associated with Immune Checkpoint Inhibitors: A Systematic Review.Diagnostics (Basel, Switzerland) · 2024Review
- Immune Checkpoint Inhibitor-induced Myositis.Rheumatic diseases clinics of North America · 2024Review
- Immune interactions in pembrolizumab (PD-1 inhibitor) cancer therapy and cardiovascular complications.American journal of physiology. Heart and circulatory physiology · 2023Review
- Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases.Diagnostics (Basel, Switzerland) · 2023Review
- Drug therapy for myocarditis induced by immune checkpoint inhibitors.Frontiers in pharmacology · 2023Review
- Immunopathogenesis of Immune Checkpoint Inhibitor Induced Myocarditis: Insights from Experimental Models and Treatment Implications.Biomedicines · 2023Review
- Cardiotoxicity of Immune Checkpoint Inhibitors: Beyond Myocarditis.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2022Article
- Multicenter, double-blind, placebo-controlled trial of seviprotimut-L polyvalent melanoma vaccine in patients with post-resection melanoma at high risk of recurrence.Journal for immunotherapy of cancer · 2021Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundImmune checkpoint inhibition is part of standard systemic management for many advanced malignancies. Toxicities from this treatment approach are unpredictable, though usually reversible with management per established guidelines. Some patients suffer major morbidity and treatment-related mortality from these agents in an unpredictable manner. Cardiac and neurologic complications are rare, but can result in serious clinical consequences.
methodsWe describe the presentation, management, and outcomes of eight sequential cases of combined cardiac and neurologic toxicities resulting in severe illness and demonstrating lack of rapid response to immunosuppression.
resultsOur cohort consisted of six males and two females with an average age of 73.5 years (61-89 years). There were four patients with melanoma, and one patient each with urothelial carcinoma, renal cell carcinoma, breast cancer, and non-small cell lung cancer. Four patients received combination immunotherapy and four patients received monotherapy. The median time to presentation from treatment initiation was 27 days (11-132 days). All patients had a cardiovascular and neurologic toxicity, and most had hepatitis and myositis. The cardiac signs and symptoms were the prominent initial features of the clinical presentation. Each patient was managed by a multidisciplinary team and received a range of immunosuppressive agents. All patients died as a consequence of the immune related adverse events.
conclusionsThe evaluation of patients with cardiac adverse events from immunotherapy, should include assessment of overlapping toxicities such as myasthenia gravis and myositis. Providers should be aware of the potential for an extended duration of disability and slow improvement for certain toxicities as these expectations may factor prominently in goals of care decisions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.