Immune checkpoint inhibitor cardiomyotoxicity: a case series of five patients and development of a clinical management algorithm.

Immune checkpoint inhibitor (ICI) therapies have revolutionised the management of a range of malignancies. However, the syndrome of ICI induced cardiomyotoxicity, also reported as triple "M" syndrome (myasthenia gravis, myositis and myocarditis) is an unfortunate severe consequence in up to 1%-2% of patients receiving ICI, with an associated mortality of up to 50%. Based on international evidence and local experience, we have developed a clinical pathway in our institution as a guide to the early identification and targeted management of this condition.