Elsevier

ESMO Open

Volume 6, Issue 4, August 2021, 100216
ESMO Open

Review
Clinical implications of isolated troponinemia following immune checkpoint inhibitor therapy

https://doi.org/10.1016/j.esmoop.2021.100216Get rights and content
Under a Creative Commons license
open access

Highlights

  • The clinical interpretation and implication of troponin levels remain unclear.

  • Many mechanisms can contribute to an asymptomatic increase in troponinemia.

  • Conditions are urgently needed to correctly interpret troponin results.

  • Prospective studies are needed before recommending troponin surveillance as a standard of care.

Cardiovascular adverse events induced by immune checkpoint inhibitors (ICIs) have gained significant interest over the past decade due to their impact on short- and long-term outcomes. They were initially thought to be rare, but the increasing use of ICIs in the treatment of both advanced and early stages of various malignancies has resulted in a substantial increase in their incidence. Different guidelines have proposed screening measures for ICI-induced myocarditis by incorporating troponin measurements at baseline and during the first few weeks of treatment. However, no specific guidelines have been developed yet regarding the interpretation of an asymptomatic rise in troponins. This state-of-the art review aims to provide an overview of the clinical relevance of elevated troponins during checkpoint inhibition and recommendations on how to manage elevated troponin levels during ICI therapy.

Key words

cardiac troponin
cardiotoxicity
myocarditis
cancer
immunotherapy
biomarker

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