Cardiac side effect

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Science  25 Nov 2016:
Vol. 354, Issue 6315, pp. 1017-1018
DOI: 10.1126/science.354.6315.1017-b

Antibodies that block CTLA-4 (cytotoxic T lymphocyte–associated antigen 4) and PD-1 (programmed death 1) allow T cells to launch antitumor immune responses. Although these checkpoint inhibitors improve survival in melanoma patients, inflammation of other tissues is a common side effect. Johnson et al. report that two melanoma patients treated with a combination of the checkpoint inhibitors developed fatal cardiac damage. Biopsies revealed that T cells and macrophages that infiltrated the heart were the same as those found in skeletal muscle and the tumor. Neither patient had cardiac risk factors other than hypertension. Review of a safety database suggests that severe myocarditis from such combination therapy affects less than 1% of patients. The mechanism for this rare toxic effect is not known.

New Engl. J. Med. 375, 1749 (2016); Proc. Natl. Acad. Sci. U.S.A. 10.1073/pnas.1603325113 (2016).

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