Biomarkers Associated With Immune Checkpoint Inhibitor Myocarditis Revealed
By LabMedica International staff writers Posted on 27 Dec 2022 |

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of various malignancies. The development and widespread use of ICIs have led to improved outcomes with a generally better tolerated side-effect profile compared with other therapies.
Immune-related adverse events (irAEs), while infrequent, are a direct result of the mechanism of action of ICIs, with disinhibition of T cells leading to a complex cascade of dysregulation of immune self-tolerance that can occur in almost any organ system. Myocarditis is the most severe cardiovascular manifestation of irAEs, with an estimated incidence of 1% to 2%.
A large team of international medical scientists led by those at the University of Michigan (Ann Arbor, MI, USA) conducted an observational cohort study of all adult (≥18 years of age) patients who had received treatment with single or dual ICI at Michigan Medicine between June 2014 and December 2021. Serial testing for aspartate aminotransferase (AST) and alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase during ICI therapy was carried out on a weekly basis in all patients receiving ICI at Michigan Medicine for the duration of ICI therapy.
A total of 2,606 adult patients (mean age 64 ± 13 years; 60.7% men) received at least one dose of ICI between June 2014 and December 2021. Of these patients, 27 (1.0%) or 0.14 (95% CI: 0.09-0.21) cases per 10,000 person-years had a diagnosis of myocarditis attributed to ICI therapy, of which five cases were classified as definite, four as probable, and 18 as possible. The overall number of patients who received ICI therapy and the incidence of ICI myocarditis increased steadily each year from 2014 to 2021.
The team reported that at diagnosis, patients with myocarditis had an elevated high-sensitivity troponin T (100%), ALT (88.9%), AST (85.2%), CPK (88.9%), and lactate dehydrogenase (92.6%). Findings were confirmed in an independent cohort of 30 patients with biopsy-confirmed ICI myocarditis. A total of 95% of patients with ICI myocarditis had elevations in at least three biomarkers compared with 5% of patients without myocarditis. Among the non-cardiac biomarkers, only CPK was associated (per 100% increase) with the development of myocarditis (HR: 1.83) and all-cause mortality (HR: 1.10) in multivariable analysis. Elevations in CPK had a sensitivity of 99% and specificity of 23% for identifying myocarditis.
The authors concluded that although its incidence is rare, ICI myocarditis is associated with poor outcomes. Thus, identifying patients with myocarditis is crucial to provide early intervention and treatment. Acute ICI myocarditis co-occurs with other irAEs. Thus, evidence of possible irAEs such as elevated AST, ALT, and CPK during the first three months of ICI therapy should prompt further evaluation for ICI myocarditis, and normal levels of these biomarkers could rule out clinically significant acute ICI myocarditis. The study was published on December 20, 2022 in the journal JACC: CardioOncology.
Related Links:
University of Michigan
Latest Clinical Chem. News
- Paper-Based Device Boosts HIV Test Accuracy from Dried Blood Samples
- AI-Powered Raman Spectroscopy Method Enables Rapid Drug Detection in Blood
- Novel LC-MS/MS Assay Detects Low Creatinine in Sweat and Saliva
- Biosensing Technology Breakthrough Paves Way for New Methods of Early Disease Detection
- New Saliva Test Rapidly Identifies Paracetamol Overdose
- POC Saliva Testing Device Predicts Heart Failure in 15 Minutes
- Screening Tool Detects Multiple Health Conditions from Single Blood Drop
- Integrated Chemistry and Immunoassay Analyzer with Extensive Assay Menu Offers Flexibility, Scalability and Data Commutability
- Rapid Drug Test to Improve Treatment for Patients Presenting to Hospital
- AI Model Detects Cancer at Lightning Speed through Sugar Analyses
- First-Ever Blood-Powered Chip Offers Real-Time Health Monitoring
- New ADLM Guidance Provides Expert Recommendations on Clinical Testing For Respiratory Viral Infections
- 3D Printed Point-Of-Care Mass Spectrometer Outperforms State-Of-The-Art Models
- POC Biomedical Test Spins Water Droplet Using Sound Waves for Cancer Detection
- Highly Reliable Cell-Based Assay Enables Accurate Diagnosis of Endocrine Diseases
- New Blood Testing Method Detects Potent Opioids in Under Three Minutes
Channels
Molecular Diagnostics
view channel
Innovative Bio-Detection Platform Improves Early Cancer Screening and Monitoring
Cancer remains one of the leading causes of death globally, underscoring the critical need for more advanced, efficient, and early detection methods. Circulating tumor cells (CTCs) are cells that have... Read more
Blood Test Could Help More Women Survive Aggressive Triple Negative Breast Cancer
Cancer research shows that over 90% of women diagnosed with breast cancer at its earliest stage survive for five years or more. However, this survival rate dramatically decreases to just 30% when the cancer... Read more
CSF Test Distinguishes Prion Disease from Other Causes of Rapidly Progressive Dementia
Rapidly progressive dementias are a category of dementia where patients experience a swift decline from the onset of symptoms to losing functional independence, typically within two years.... Read more
Newly Identified Stroke Biomarkers Pave Way for Blood Tests to Quickly Diagnose Brain Injuries
Each year, nearly 800,000 individuals in the U.S. experience a stroke, which occurs when blood flow to specific areas of the brain is insufficient, causing brain cells to die due to a lack of oxygen.... Read moreHematology
view channel
Non-Invasive Prenatal Test for Fetal RhD Status Demonstrates 100% Accuracy
In the United States, approximately 15% of pregnant individuals are RhD-negative. However, in about 40% of these cases, the fetus is also RhD-negative, making the administration of RhoGAM unnecessary.... Read more
WBC Count Could Predict Severity of COVID-19 Symptoms
The global health crisis caused by the SARS-CoV-2 virus continues to impact millions of people worldwide, with many experiencing persistent symptoms months after the initial diagnosis. Cognitive impairment... Read more
New Platelet Counting Technology to Help Labs Prevent Diagnosis Errors
Accurate platelet count testing is a significant challenge for laboratories. Inaccurate results can lead to misdiagnosis, missed diagnoses, and delayed treatment for a variety of potentially fatal conditions,... Read more
Streamlined Approach to Testing for Heparin-Induced Thrombocytopenia Improves Diagnostic Accuracy
Heparin-induced thrombocytopenia (HIT), a serious side effect of the blood thinner heparin, is difficult to diagnose because thrombocytopenia, or low platelet count, can be caused by a variety of factors... Read moreImmunology
view channelCerebrospinal Fluid Test Predicts Dangerous Side Effect of Cancer Treatment
In recent years, cancer immunotherapy has emerged as a promising approach where the patient's immune system is harnessed to fight cancer. One form of immunotherapy, called CAR-T-cell therapy, involves... Read more
New Test Measures Preterm Infant Immunity Using Only Two Drops of Blood
Preterm infants are particularly vulnerable due to their organs still undergoing development, which can lead to difficulties in breathing, eating, and regulating body temperature. This is especially true... Read more
Simple Blood Test Could Help Choose Better Treatments for Patients with Recurrent Endometrial Cancer
Endometrial cancer, which develops in the lining of the uterus, is the most prevalent gynecologic cancer in the United States, affecting over 66,000 women annually. Projections indicate that in 2025, around... Read moreMicrobiology
view channel
Gastrointestinal Panel Delivers Rapid Detection of Five Common Bacterial Pathogens for Outpatient Use
Acute infectious gastroenteritis results in approximately 179 million cases each year in the United States, leading to a significant number of outpatient visits and hospitalizations. To address this, a... Read more
Rapid PCR Testing in ICU Improves Antibiotic Stewardship
A collaborative study led by the University of Plymouth (Devon, UK) has shown that rapid polymerase chain reaction (PCR) testing in the intensive care unit (ICU) improved antibiotic stewardship compared... Read morePathology
view channel
Informatics Solution Elevates Laboratory Efficiency and Patient Care
QuidelOrtho Corporation (San Diego, CA, USA) has introduced the QuidelOrtho Results Manager System, a cutting-edge informatics solution designed to meet the increasing demands of modern laboratories.... Read more
Microfluidic Device Assesses Stickiness of Tumor Cells to Predict Cancer Spread
Ductal carcinoma in situ (DCIS), a type of early-stage breast cancer, is often referred to as stage zero breast cancer. In many cases, it remains harmless and does not spread beyond the milk ducts where... Read more
New AI Tool Outperforms Previous Methods for Identifying Colorectal Cancer from Tissue Sample Analysis
Tissue analysis typically involves a pathologist reviewing scanned digital slides from a patient’s intestinal sample and marking specific areas, such as those where cancerous and related tissues are present.... Read moreTechnology
view channel
POC Paper-Based Sensor Platform to Transform Cardiac Diagnostics
Cardiovascular diseases continue to be the leading cause of death worldwide, accounting for over 19 million fatalities annually. Early detection of myocardial infarction (MI), commonly known as a heart... Read more
Study Explores Impact of POC Testing on Future of Diagnostics
In today’s rapidly changing world, having quick and accurate access to medical information is more crucial than ever. Point-of-Care Diagnostics (PoC-D) and Point-of-Care Testing (PoC-T) are making this... Read more
Low-Cost, Fast Response Sensor Enables Early and Accurate Detection of Lung Cancer
Cancer biomarkers are valuable tools for early diagnosis as their concentration in body fluids, such as serum, can be measured to detect the disease at an earlier stage. Additionally, serum levels of these... Read moreIndustry
view channel
CACLP 2025 Unites Global Innovators in IVD Industry
CACLP (Shanghai, China) will be holding the 22nd China International In Vitro Diagnostic Expo, the largest and most influential gathering of the IVD industry in China, 22-24 March 2025 at the Hangzhou... Read more
Bio-Rad to Acquire Digital PCR Developer Stilla Technologies
Bio-Rad Laboratories (Hercules, CA, USA) has entered into a binding offer to purchase all equity interests in Stilla Technologies (Villejuif, France). The acquisition remains subject to consultation with... Read more