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Cardiotoxicity associated with immune checkpoint inhibitors: Systematic review and meta-analysis

Lavinia Piazza1, Anna Carollo2, Enrica Di Martino2

  • 1Università degli Studi di Milano, Department of Pharmacy, Italy.

Critical Reviews in Oncology/Hematology
|December 12, 2024
PubMed
Abstract

Insights

Immune checkpoint inhibitors (ICIs) like PD-1, PD-L1, and CTLA-4 therapies increase cardiotoxicity risk. Early cardiac screening is vital for managing potential complications and improving patient outcomes during cancer treatment.

Area of Science:

  • Oncology
  • Cardiology
  • Immunotherapy

Background:

  • Immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1, and CTLA-4 are crucial in cancer therapy.
  • Cardiac toxicity is a recognized but potentially underestimated adverse effect of these treatments.

Purpose of the Study:

  • To systematically review and assess the risk of cardiac toxicity in patients receiving approved PD-1, PD-L1, and CTLA-4 inhibitors.
  • To quantify the incidence and types of cardiac adverse events associated with ICI therapy.

Main Methods:

  • Systematic review of 2272 articles.
  • Inclusion of 11 phase II and III clinical trials.
  • Analysis of cardiac adverse events in 5463 patients.

Main Results:

  • 175 cardiac adverse events were reported.
  • Atrial fibrillation was the most common (12%), followed by cardiac arrest and failure (6%).
  • ICI treatment significantly increased cardiotoxicity risk (RR=1.62, OR=1.71).

Conclusions:

  • The frequency and severity of ICI-associated cardiotoxicity are underestimated.
  • Systematic cardiological screening is necessary to detect and manage potential cardiac complications.
  • Proactive cardiac monitoring can optimize treatment outcomes for patients receiving ICIs.
Keywords:
CTLA-4 inhibitorCancerCardiovascular adverse eventImmune checkpoint inhibitorImmunotherapyMeta-analysisPD-1/PD-L1 inhibitorSystematic review

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