Immune checkpoint inhibitor-associated cardiovascular toxicities: A review

Area of Science:

• Oncology
• Cardiology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) have transformed cancer therapy by harnessing the immune system.
• Adverse reactions to ICIs are frequent, impacting multiple organs and limiting clinical application.
• Cardiovascular toxicity from ICIs, though less common, carries significant morbidity and mortality risks.

Purpose of the Study:

• To review the incidence, mechanisms, clinical features, diagnosis, and management of cardiovascular toxicity associated with immune checkpoint inhibitors.
• To highlight the importance of recognizing and addressing ICI-induced cardiac adverse events.

Main Methods:

• Literature review focusing on immune checkpoint inhibitors and cardiovascular toxicity.
• Analysis of reported cases and existing research on ICI-related cardiovascular adverse events.
• Synthesis of information on diagnostic approaches and therapeutic strategies.

Main Results:

• Cardiovascular toxicities encompass myocarditis, pericarditis, Takotsubo syndrome, arrhythmias, vasculitis, acute coronary syndrome, and venous thromboembolism.
• The precise mechanisms driving ICI-associated cardiovascular toxicity are not fully understood.
• Diagnosis involves clinical symptoms, physical examination, laboratory tests, ECG, imaging, and pathology.
• Treatment strategies depend on toxicity severity and include drug discontinuation, corticosteroids, immunosuppressants, and standard cardiac care.

Conclusions:

• Cardiovascular toxicity is a critical concern with immune checkpoint inhibitors, necessitating vigilant monitoring and prompt management.
• Further research into the underlying mechanisms of ICI-induced cardiotoxicity is essential for developing targeted therapies.
• Integrated management involving oncologists and cardiologists is vital for optimizing patient outcomes.