Cardiovascular Complications of Novel Anti-Cancer Immunotherapy: Old Problems from New Agents?

Area of Science:

• Cardio-oncology
• Translational medicine
• Immunotherapy

Background:

• Novel anti-cancer therapies offer improved patient outcomes but carry risks of cardiovascular complications.
• Limited clinical experience with new anti-cancer agents necessitates proactive assessment of cardiotoxicity risk factors.
• Cardiovascular complications can arise from advanced cancer treatments, impacting patient safety and treatment efficacy.

Purpose of the Study:

• To propose cardiac function monitoring strategies for novel, potentially cardiotoxic anti-cancer agents.
• To review cardiovascular complications associated with novel anti-cancer immunotherapies, including immune checkpoint inhibitors (ICIs) and chimeric antigen receptor (CAR) T-cell therapy.
• To emphasize the importance of pre-treatment risk assessment and cardiologist consultation for high-risk patients.

Main Methods:

• Review of current literature on cardiotoxicity associated with novel anti-cancer therapies.
• Analysis of cardiovascular complications from immune checkpoint inhibitors (ICIs) and CAR T-cell therapy.
• Discussion of diagnostic tools such as biomarkers, electrocardiography, and echocardiography for detecting subclinical cardiotoxicity.

Main Results:

• Immune checkpoint inhibitors (ICIs) can induce potentially fatal myocarditis, requiring early, high-dose corticosteroid treatment.
• CAR T-cell therapy is associated with cytokine release syndrome, which can lead to circulatory collapse, managed with supportive care and tocilizumab.
• Biomarkers, ECG, and echocardiography are vital for monitoring cardiac function and detecting subclinical cardiotoxicity during treatment.

Conclusions:

• Proactive cardiac risk assessment and tailored monitoring plans are essential for patients undergoing novel anti-cancer therapies.
• Early detection and prompt intervention are critical for managing cardiotoxicity, particularly myocarditis from ICIs and cytokine release syndrome from CAR T-cell therapy.
• Collaboration between oncologists and cardiologists is vital to optimize patient care and mitigate cardiovascular risks associated with modern cancer treatments.