Cargando…

Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings

Immune checkpoint inhibitors are promising agents for anticancer therapy. But despite their high efficacy in the treatment of solid tumors, there is still a problem with immune-related adverse events, especially cardiovascular complications with a very high mortality rate. Myocarditis or ischemic he...

Descripción completa

Detalles Bibliográficos
Autores principales: Kushnareva, Ekaterina, Stepanova, Maria, Artemeva, Elizaveta, Shuginova, Tatyana, Kushnarev, Vladimir, Simakova, Maria, Moiseenko, Fedor, Moiseeva, Olga
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008445/
https://www.ncbi.nlm.nih.gov/pubmed/35432332
http://dx.doi.org/10.3389/fimmu.2022.871542
_version_ 1784687056721543168
author Kushnareva, Ekaterina
Stepanova, Maria
Artemeva, Elizaveta
Shuginova, Tatyana
Kushnarev, Vladimir
Simakova, Maria
Moiseenko, Fedor
Moiseeva, Olga
author_facet Kushnareva, Ekaterina
Stepanova, Maria
Artemeva, Elizaveta
Shuginova, Tatyana
Kushnarev, Vladimir
Simakova, Maria
Moiseenko, Fedor
Moiseeva, Olga
author_sort Kushnareva, Ekaterina
collection PubMed
description Immune checkpoint inhibitors are promising agents for anticancer therapy. But despite their high efficacy in the treatment of solid tumors, there is still a problem with immune-related adverse events, especially cardiovascular complications with a very high mortality rate. Myocarditis or ischemic heart disease progression is not the only possible cause of cardiovascular death in patients treated with checkpoint inhibitors. We report a case of a patient with mucinous carcinoma of the lung, with a previous history of hypertension and moderate left ventricular dysfunction. The patient was prescribed atezolizumab, but the first atezolizumab infusion resulted in the patient cardiovascular death. Postmortem histopathological evaluation of myocardium revealed several possible reasons for hemodynamic instability: tumor embolism of the coronary arteries, micrometastases of mucinous carcinoma in the myocardium, and myocarditis diagnosed by both Dallas and immunohistochemistry criteria. In addition, testing for expression of PD-L1 detected the high levels of membranous and cytoplasmic PD-L1 protein even in the myocardium area free from tumor cells. The present clinical case demonstrates a problem of cardiovascular death in patients treated with checkpoint inhibitors and actualizes the need for future research of potential risk factors for cardiovascular complications.
format Online
Article
Text
id pubmed-9008445
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-90084452022-04-15 Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings Kushnareva, Ekaterina Stepanova, Maria Artemeva, Elizaveta Shuginova, Tatyana Kushnarev, Vladimir Simakova, Maria Moiseenko, Fedor Moiseeva, Olga Front Immunol Immunology Immune checkpoint inhibitors are promising agents for anticancer therapy. But despite their high efficacy in the treatment of solid tumors, there is still a problem with immune-related adverse events, especially cardiovascular complications with a very high mortality rate. Myocarditis or ischemic heart disease progression is not the only possible cause of cardiovascular death in patients treated with checkpoint inhibitors. We report a case of a patient with mucinous carcinoma of the lung, with a previous history of hypertension and moderate left ventricular dysfunction. The patient was prescribed atezolizumab, but the first atezolizumab infusion resulted in the patient cardiovascular death. Postmortem histopathological evaluation of myocardium revealed several possible reasons for hemodynamic instability: tumor embolism of the coronary arteries, micrometastases of mucinous carcinoma in the myocardium, and myocarditis diagnosed by both Dallas and immunohistochemistry criteria. In addition, testing for expression of PD-L1 detected the high levels of membranous and cytoplasmic PD-L1 protein even in the myocardium area free from tumor cells. The present clinical case demonstrates a problem of cardiovascular death in patients treated with checkpoint inhibitors and actualizes the need for future research of potential risk factors for cardiovascular complications. Frontiers Media S.A. 2022-03-31 /pmc/articles/PMC9008445/ /pubmed/35432332 http://dx.doi.org/10.3389/fimmu.2022.871542 Text en Copyright © 2022 Kushnareva, Stepanova, Artemeva, Shuginova, Kushnarev, Simakova, Moiseenko and Moiseeva https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Kushnareva, Ekaterina
Stepanova, Maria
Artemeva, Elizaveta
Shuginova, Tatyana
Kushnarev, Vladimir
Simakova, Maria
Moiseenko, Fedor
Moiseeva, Olga
Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings
title Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings
title_full Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings
title_fullStr Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings
title_full_unstemmed Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings
title_short Case Report: Multiple Causes of Cardiac Death After the First Infusion of Atezolizumab: Histopathological and Immunohistochemical Findings
title_sort case report: multiple causes of cardiac death after the first infusion of atezolizumab: histopathological and immunohistochemical findings
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008445/
https://www.ncbi.nlm.nih.gov/pubmed/35432332
http://dx.doi.org/10.3389/fimmu.2022.871542
work_keys_str_mv AT kushnarevaekaterina casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings
AT stepanovamaria casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings
AT artemevaelizaveta casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings
AT shuginovatatyana casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings
AT kushnarevvladimir casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings
AT simakovamaria casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings
AT moiseenkofedor casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings
AT moiseevaolga casereportmultiplecausesofcardiacdeathafterthefirstinfusionofatezolizumabhistopathologicalandimmunohistochemicalfindings