Subclinical ICI Myocarditis Troponin — SCE Medical Oncology MCQ
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Correct answer: C — Hold nivolumab and obtain serial biomarkers plus urgent cardio-oncology imaging
An unexplained troponin rise during checkpoint therapy warrants a treatment hold, serial biomarkers and urgent cardio-oncology assessment for potentially lethal myocarditis. Continue nivolumab and repeat troponin plus ECG within forty-eight hours: continued dosing is unsafe until an immune cardiac signal has been characterised. Hold nivolumab and arrange coronary angiography as the sole cardiac test: angiography may assess coronary disease but does not replace myocarditis biomarkers and imaging. Hold nivolumab and commence colchicine for presumed immune pericarditis: colchicine targets pericardial inflammation, which the current findings do not establish. Continue nivolumab and arrange ambulatory rhythm monitoring for seven days: rhythm monitoring cannot exclude subclinical immune myocarditis.
Reference: 2022 ESC guideline on cardio-oncology (Published August 2022; current ESC guideline): https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/cardio-oncology/; OPDIVO 10 mg/mL UK summary of product characteristics (Current UK SmPC, updated July 2026): https://www.medicines.org.uk/emc/product/6888/smpc