Researchers from China reported the rare case of a patient with cholangiocarcinoma who developed myocarditis following teriprizumab treatment combined with paclitaxel and gemcitabine. Following the diagnosis of myocarditis, immunotherapy was permanently discontinued, and the patient survived.  

“Early identification and intervention are the keys to improving the prognosis of immune myocarditis,” the researchers concluded.

The case study is published in the Journal of International Medical Research.


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Cardiac toxicities are rare but life-threatening with immune checkpoint inhibitors. The case presented here is that of a male, who enrolled in a phase 2 clinical trial testing the effect of teriprizumab combined with paclitaxel and gemcitabine as a first-line therapy for cholangiocarcinoma. The patient was 71 years of age. The patient developed myocarditis 29 days after the first infusion with teriprizumab.

Read more about the treatment of cholangiocarcinoma

Initially, he was asymptomatic when he went to the hospital to receive his remaining treatment, although his troponin I and myocardial enzymes were substantially elevated. Within 16 hours of admission, he developed palpitations, dizziness, and syncope. 

He underwent electrocardiography, which showed third-degree atrioventricular block and frequent ventricular premature contractions. 

He was treated with high-dose corticosteroids, and a permanent pacemaker was installed. 

“The key in cases of suspected immune myocarditis is to raise awareness of the condition and initiate corticosteroid therapy immediately to alleviate symptoms and decrease the risk of death,” the researchers wrote.

Teriprizumab is a human monoclonal antibody targeting programmed death which has been approved in China since 2018. 

Cholangiocarcinoma is a group of rare malignant tumors originating from the cells of the biliary tree. Treatment options for the disease are limited and usually involve surgical intervention followed by adjuvant therapy. The first-line chemotherapy currently available for patients with advanced unresectable disease consists of gemcitabine combined with cisplatin. Capecitabine has also shown efficacy in patients who have undergone surgical procedures.

Reference

Ye Y, Li Y, Zhang S, Han G. Teriprizumab-induced myocarditis in a patient with cholangiocarcinoma: a case report. J Int Med Res. Published online October 27, 2022. doi: 10.1177/03000605221133259