Refining the treatment of immune checkpoint inhibitor associated myocarditis challenges, innovations, and rechallenge considerations

Refining the treatment of immune checkpoint inhibitor associated myocarditis challenges, innovations, and rechallenge considerations | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 9 March 2026 V1 Latest version Share on Refining the treatment of immune checkpoint inhibitor associated myocarditis challenges, innovations, and rechallenge considerations Authors : Raluca Mincu [email protected] , Lisa Zimmer , Dimitra Vlachopoulou , Elias Haj Yehia , Julia Hoffmann , Lars Michel , Elisabeth Livingstone , Dirk Schadendorf , Alpaslan Tasdogan , Matthias Totzeck , and Tienush Rassaf Authors Info & Affiliations https://doi.org/10.22541/au.177304887.77847424/v1 137 views 66 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Immune checkpoint inhibitor (ICI)– associated myocarditis has emerged as a severe and clinically complex immune-related toxicity that poses significant challenges for therapeutic decision-making in routine cardio-oncological care. High-dose corticosteroids remain the first-line therapy, yet their timing, dosage, and tapering require careful clinical judgment. Early initiation substantially improves outcomes, but steroid resistance or delayed response is common and necessitates escalation to second-line immunosuppression. The heterogeneity of available rescue therapies, including mycophenolate mofetil, abatacept, JAK inhibitors, plasmapheresis, and other targeted agents, creates significant uncertainty, as evidence is largely limited to case reports and small case series. Management of ICI-induced myocarditis requires balancing immunosuppression with cancer control, particularly when considering rechallenge. Prognostic uncertainty and limited long-term data necessitate multidisciplinary, risk-adapted care, while robust prospective evidence and standardized algorithms remain urgently needed. This review summarizes current management strategies for ICI–induced myocarditis, encompassing early high-intensity corticosteroid therapy, treatment of fulminant disease, and the use of second-line immunosuppressive agents. Key clinical challenges, including steroid resistance, preservation of antitumour efficacy, ICI rechallenge, and emerging biomarker-driven and translational approaches, are also addressed to support individualized care. Supplementary Material File (mincuetal. refining the treatment of ici.docx) Download 872.57 KB Information & Authors Information Version history V1 Version 1 09 March 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Authors Affiliations Raluca Mincu [email protected] West German Heart and Vascular Center Essen University Hospital Essen View all articles by this author Lisa Zimmer West German Skin Tumor Center Essen University Hospital Essen View all articles by this author Dimitra Vlachopoulou West German Heart and Vascular Center Essen University Hospital Essen View all articles by this author Elias Haj Yehia West German Heart and Vascular Center Essen University Hospital Essen View all articles by this author Julia Hoffmann West German Heart and Vascular Center Essen University Hospital Essen View all articles by this author Lars Michel West German Heart and Vascular Center Essen University Hospital Essen View all articles by this author Elisabeth Livingstone West German Skin Tumor Center Essen University Hospital Essen View all articles by this author Dirk Schadendorf West German Skin Tumor Center Essen University Hospital Essen View all articles by this author Alpaslan Tasdogan West German Skin Tumor Center Essen University Hospital Essen View all articles by this author Matthias Totzeck West German Heart and Vascular Center Essen University Hospital Essen View all articles by this author Tienush Rassaf West German Heart and Vascular Center Essen University Hospital Essen View all articles by this author Metrics & Citations Metrics Article Usage 137 views 66 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Raluca Mincu, Lisa Zimmer, Dimitra Vlachopoulou, et al. Refining the treatment of immune checkpoint inhibitor associated myocarditis challenges, innovations, and rechallenge considerations. Authorea . 09 March 2026. DOI: https://doi.org/10.22541/au.177304887.77847424/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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