Cardiotoxicities associated with immune checkpoint inhibitors

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) are novel cancer therapies offering significant survival benefits for advanced malignancies.
• While generally well-tolerated, ICIs can induce immune-mediated toxicities affecting multiple organ systems.
• Immune-mediated cardiotoxicity is an emerging, serious adverse event associated with ICI therapy.

Purpose of the Study:

• To review the clinical manifestations, diagnostic methods, and management strategies for cardiotoxicity linked to immune checkpoint inhibitors.
• To highlight the diverse presentations of ICI-associated cardiotoxicity, including myocarditis, arrhythmias, and pericardial disease.
• To discuss the hypothesized mechanisms and current treatment limitations for this condition.

Main Methods:

• This review synthesizes current literature on immune checkpoint inhibitor (ICI)-related cardiotoxicity.
• It covers clinical presentations, diagnostic workup including biomarkers and imaging, and endomyocardial biopsy.
• Management strategies, primarily focusing on immunosuppression, are also discussed.

Main Results:

• ICI-associated cardiotoxicity presents with varied cardiac conditions such as myocarditis, arrhythmias, pericardial disease, and Takotsubo cardiomyopathy.
• The underlying mechanism is thought to involve T-cell activation and infiltration into cardiac tissue.
• Diagnosis relies on cardiac biomarkers, imaging, and potentially endomyocardial biopsy.

Conclusions:

• Immune-mediated cardiotoxicity is a rare but critical complication of ICI therapy.
• Prompt diagnosis and management, often involving immunosuppression, are essential for patient outcomes.
• Further research is needed to fully elucidate mechanisms and optimize treatment strategies.