Abstract
Recent years have brought major advancements in the use of immune therapy and specifically immune checkpoint inhibitors (ICIs) in cancer patients, with expanding indications for various malignancies resulting in the treatment of a large and increasing number of patients. While this therapy significantly improves outcomes in a variety of hematologic and solid tumors, the use of ICIs is associated with a substantial risk of immune-related adverse events. Cardiovascular toxicity, while not the most common side effect of ICIs, is associated with significant morbidity and mortality. It is therefore crucial for oncologists and cardiologists, as well as internists and emergency room physicians, to have a good understanding of this increasingly common clinical problem. In the present review, we discuss the cardiac aspects of ICI therapy with special emphasis on the clinical manifestations of their cardiovascular toxicity, diagnostic approaches, treatment and suggested surveillance.
Highlights
Recent years have brought major advancements in the use of immune therapy and immune checkpoint inhibitors (ICIs) in cancer patients, with expanding indications for various malignancies resulting in the treatment of a large and increasing number of patients [1]
Therapy was first granted in 2011 and, to date, more than 50 indications have been approved. This therapy is being utilized earlier in the disease course of a variety of tumors. While this therapy significantly improves outcomes in a variety of hematologic and solid tumors, the use of ICI is associated with a substantial risk of immune-related adverse events
The clinical presentation of myocarditis in the setting of ICI therapy is broad and may include chest pain with or without symptoms related to ventricular dysfunction, such as shortness of breath and fatigue
Summary
Recent years have brought major advancements in the use of immune therapy and immune checkpoint inhibitors (ICIs) in cancer patients, with expanding indications for various malignancies resulting in the treatment of a large and increasing number of patients [1]. While ICI cardiovascular which act against antigens shared by tumor cells and cardiovascular (CV) toxicity is related presumably to the clonal expansion of T lymphocytes, which act mechanisms remain unclear. Programmed cell death protein-1 cardiac such as with troponin cardiomyocyte necrosis, on show T lymphocyte infiltration andbiomarkers, severe myocarditis a riseand in cardiac biomarkers, of these models, the animals developed severe heart failure such as troponin and cardiomyocyte necrosis, on pathology. It has been shown that defects in PDL-1 function in dendritic cells located in vessel walls can contribute to inflammatory vasculitis [10] Another potential mechanism of ICI-related cardiotoxicity may be the interactions of these agents with previous cancer therapy. Previous treatment with cardiotoxic agents, such as anthracyclines, may lead to the exposure of myocardial antigens and potentiate ICI toxicity This synergistic mechanism was demonstrated with radiation therapy as well [11]
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