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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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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 |
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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 |
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