A Better Treatment May Exist for Immunotherapy-Related Heart Problems

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Standard corticosteroid use may not be the best treatment for patients with cancer who experience immunotherapy-related heart issues, research showed.

Patients with cancer who are treated with immunotherapy may develop heart issues, referred to as cardiotoxicity. While these complications are commonly treated with corticosteroids, a different therapy may be more effective and improve survival, according to recent research that was published in Cancer Discovery.

“Immunotherapy wakes up the immune system, but it sometimes wakes up autoreactive T cells that destroy your own body,” study author Dr. Joe-Elie Salem, professor at Sorbonne Université, and executive assistant director of one of France’s Clinical Investigation Centers focused on cardio-metabolism, said in a press release. “The heart is at the top of the list of organs you don’t want to harm.”

But unfortunately, some people — approximately 1% of those undergoing immunotherapy treatment — do experience immunotherapy-related myocarditis (damage to the heart tissue). The standard treatment for myocarditis is to administer a high-dose corticosteroids, which can be too much treatment for some and too little treatment for others, leading to approximately 20% to 60% of patients to die, according to Salem.

“We have to acknowledge that not all patients need the whole package; you may need all of it for the severe cases and only some of it for intermediate cases, or even none of it for persistently asymptomatic cases,” Salem said. “Even if it’s debated in the literature whether we should screen for and monitor the severity of every patient, for me, there’s no question.”

Salem and his team sought out to determine if a more effective immune-related myocarditis treatment exists. So, in a study conducted in a Paris hospital, they compared the outcomes of 10 patients with immune-related myocarditis who were treated with the standard high-dose corticosteroids, to 30 patients who were given an immune-suppressing therapy (Orencia [abatacept], Jakafi (ruxolitinib); and/or mechanical ventilation.

In the experimental treatment group of 30 patients, 26 received low-dose corticosteroids as well as three infusions of high-dose Orencia. Seventeen patients were administered Jakafi in addition to Orencia. Twenty-two patients had severe myocarditis.

Patients were then monitored to see if their myocarditis spread to their respiratory system, and a total of eight patients were placed on a ventilator.

Of note, Orencia, which is commonly used to treat rheumatoid arthritis, takes a while to work, but has lasting efficacy, while Jakafi works right away, which is why the researchers believed that this would be a promising drug duo to use against immune-related myocarditis.

Study findings showed that 60% of patients in the standard corticosteroid group died, compared with 3.3% in the experimental treatment group. The researchers noted that the one patient who died in the experimental treatment group was eligible for ventilator usage, but refused.

Three months later, 40% of patients were still alive in the standard-of-care group, compared to 77% in the experimental treatment group. Further, six months after treatment, 20% and 70% of patients in the standard and experimental groups, respectively, were still alive.

“While this is not a randomized clinical trial, the significant improvement in outcomes when patients are treated with targeted therapies is very suggestive that this regimen is helpful,” Salem said.

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