Another mechanism is epitope spreading,[5] tumor cell death leads to the release of large amounts of tumor antigens and autoantigens, which triggers an inflammatory cascade.[6] It has been reported that ICI -associated myocarditis and myositis are mainly caused by damage due to infiltration of T lymphocytes with macrophages,[7,8] and studies have shown that exosomes from PD-1 inhibitor-treated macrophages significantly promote cardiomyocyte senescence.[9]. This evidence concerns the gene PDCD1 and myositis disease.