Immune checkpoint inhibitors

(nivolumab, pembrolizumab, cemiplimab, avelumab, atezolizumab, durvalumab, ipilimumab, tremelimumab...)

ECG and troponin*

before immunotherapy begins

ECG and troponin*

before each infusion

Cardiovascular symptoms/signs or

ECG abnormality or

Troponin +

Suspect myocarditis

Hold immunotherapy

Urgent cardiological evaluation

refer to myocarditis management protocol

*Assays should be carried out by the same laboratory (same type of troponin, same method of measurement).

Troponin + if >99e percentile of the URL

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University Mediterranean Center of Cardio-Oncology

North Hospital, chemin des Bourrely, 13015 Marseille, France

Aix-Marseille University

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© 2020 by Franck Thuny