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Cardiovascular Risk Profile of Nivolumab Anti-cancer Therapy: A Review of Current Literature
Zaheer Qureshi1, Zaofashan Zaheer2, Zoha Asghar3
1The Frank H. Netter M.D. School of Medicine at Quinnipiac University, Bridgeport, CT.
Objectives:
Immune checkpoint inhibitors (ICI) upregulate host antitumor immunity, proving efficacy across diverse tumor types. Currently approved ICI treatment primarily targets the programmed cell death receptor 1 (PD-1) and its ligand PD-L1, and cytotoxic T lymphocyte-antigen 4 (CTLA-4). Nivolumab is a monoclonal antibody that targets the human PD-1 receptor and is an entirely human immunoglobulin G4 (IgG4), approved by the FDA for various cancers like advanced melanoma, metastatic renal cell carcinoma, Hodgkin lymphoma, and advanced lung carcinoma. This review will summarise and discuss the recent literature on cardiotoxicity associated with nivolumab therapy.
Methods:
We searched online databases like PubMed, Scopus, Google Scholar, and Embase for articles related to Nivolumab.
Results:
Cardiotoxicity with ICI use is most commonly represented as myocarditis. Patients present with complaints of shortness of breath, palpitations, edema, and fatigue. Takotsubo cardiomyopathy, or broken heart syndrome, is characterized by systolic dysfunction of the left ventricle, mimicking a myocardial infarction but without associated coronary ischemia and with minimal elevation of cardiac enzymes. In the CHECKMATE-037 trial, ventricular arrhythmias occurred in <10% of those who received nivolumab. In a retrospective analysis of patients treated with ICI (predominantly nivolumab monotherapy) for lung cancer, 11% of the patients developed major adverse cardiac events, including myocarditis, non-ST-segment elevated myocardial infarction, supraventricular tachycardia, and pericardial disorders.
Conclusion:
Close collaboration between cardiology and oncology specialists is crucial for early detection and effective management of cardiac complications, enhancing the safety of nivolumab anticancer therapy.
Insights
Nivolumab, an immune checkpoint inhibitor, can cause cardiotoxicity, commonly presenting as myocarditis. Early detection and collaboration between cardiology and oncology are vital for managing these cardiac complications in cancer patients.
Area of Science:
- Oncology
- Immunotherapy
- Cardiology
Background:
- Immune checkpoint inhibitors (ICIs) like nivolumab enhance antitumor immunity and are approved for various cancers.
- Current ICIs primarily target programmed cell death receptor 1 (PD-1), its ligand PD-L1, and cytotoxic T lymphocyte-antigen 4 (CTLA-4).
- Nivolumab, a human IgG4 monoclonal antibody targeting PD-1, is FDA-approved for advanced melanoma, renal cell carcinoma, Hodgkin lymphoma, and lung carcinoma.
Purpose of the Study:
- To review and discuss recent literature on cardiotoxicity associated with nivolumab therapy.
- To highlight the importance of recognizing and managing cardiac adverse events in patients receiving nivolumab.
Main Methods:
- Literature search conducted on PubMed, Scopus, Google Scholar, and Embase for articles related to nivolumab.
- Analysis of reported cases and clinical trial data regarding cardiotoxicity.
Main Results:
- Cardiotoxicity from ICIs most frequently manifests as myocarditis, with symptoms including shortness of breath, palpitations, edema, and fatigue.
- Takotsubo cardiomyopathy, or "broken heart syndrome," is a form of cardiotoxicity characterized by left ventricular systolic dysfunction without coronary ischemia.
- Ventricular arrhythmias (<10%) and major adverse cardiac events (11%), including myocarditis and myocardial infarction, have been reported in patients treated with nivolumab.
Conclusions:
- Close collaboration between cardiology and oncology specialists is essential for early detection and management of cardiac complications.
- Effective management of cardiac side effects is crucial for improving the safety and efficacy of nivolumab in cancer treatment.
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