免疫检查点抑制剂（ICIs）由于其改善的疗效、生活质量和安全性而彻底改变了多种肿瘤的管理。虽然大多数免疫相关不良事件（irAEs）轻微且易于管理，但在极少数情况下，这些事件可能会危及生命，尤其是影响神经肌肉和心脏系统的事件。由于缺乏一致的数据，神经肌肉/心脏irAEs的管理并不清楚。因此，我们从选定的意大利中心收集了一些病例，以及已发表的案例报告和案例系列的个人数据，以改善对这些irAEs的理解。我们从六个意大利中心的ICIs治疗的治疗实例中收集了回顾性数据（程序性细胞死亡蛋白1或程序性死亡配体1和/或细胞毒性T淋巴细胞抗原4抑制剂），这些实例涉及任何实体瘤患者，并出现了神经肌肉和/或心血管毒性。然后，我们搜索了任何实体瘤的ICIs神经肌肉/心脏irAEs的案例报告和系列。此分析包括来自意大利机构的案例（n = 18）和我们系统的文献搜索中发现的案例报告（n = 120），总计138名患者。其中，50名（36.2％）患者的神经肌肉/心脏irAEs完全消失，在21例（15.2％）中有临床改善，但出现轻度后遗症，而53名（38.4％）患者因irAEs死亡。与较差预后显著相关的因素包括早期irAE发生，即在接受ICI的前两个周期内（Fisher P <0.0001），与仅发展肌炎或心肌炎的患者相比出现肌炎和心肌炎的临床表现（卡方P = 0.0045），以及心律失常的发生（Fisher P = 0.0070）。据我们所知，这是关于免疫相关心肌/肌炎的个别病例最大的收集。早期irAE发生，肌炎和心肌炎的同时发展，以及心律失常的出现与较差预后有关，应该鼓励进行积极的免疫调节治疗。版权所有©2023年作者。由Elsevier Ltd.出版。保留所有权利。

Immune checkpoint inhibitors (ICIs) have revolutionized the management of multiple tumors, due to improved efficacy, quality of life, and safety. While most immune-related adverse events (irAEs) are mild and easily managed, in rare cases such events may be life-threatening, especially those affecting the neuromuscular and cardiac system. The management of neuromuscular/cardiac irAEs is not clear due to the lack of consistent data. Therefore, we carried out a pooled analysis of collected cases from selected Italian centers and individual data from published case reports and case series, in order to improve our understanding of these irAEs.We collected retrospective data from patients treated in six Italian centers with ICIs (programmed cell death protein 1 or programmed death-ligand 1 and/or cytotoxic T-lymphocyte antigen 4 inhibitor) for any solid tumor who experienced neuromuscular and/or cardiovascular toxicity. Then, we carried out a search of case reports and series of neuromuscular/cardiac irAEs from ICIs with any solid tumor.This analysis includes cases from Italian institutions (n = 18) and the case reports identified in our systematic literature search (n = 120), for a total of 138 patients. Among these patients, 50 (36.2%) had complete resolution of their neuromuscular/cardiac irAEs, in 21 (15.2%) cases there was a clinical improvement with mild sequelae, and 53 (38.4%) patients died as a result of the irAEs. Factors significantly associated with worse outcomes were early irAE onset, within the first two cycles of ICI (Fisher P < 0.0001), clinical manifestation of both myositis and myocarditis when compared with patients who developed only myositis or myocarditis (chi-square P = 0.0045), and the development of arrhythmia (Fisher P = 0.0070).To the best of our knowledge, this is the largest collection of individual cases of immune-related myocarditis/myositis. Early irAE onset, concurrent development of myositis and myocarditis, as well as occurrence of arrhythmias are associated with worse outcomes and should encourage an aggressive immunomodulatory treatment.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.