Immunotherapy-Induced Cardiotoxicity: A Narrative Review of Real-World Case Reports, Recent Information and Clinical...

Immunotherapy is revolutionizing the treatment of cancer and other conditions. However, it also precipitates a loss of self-tolerance and causes immune-related adverse events (irAEs). We provide a narrative synthesis of the scopes and methods of immunotherapy and mechanisms, clinical presentation, and diagnostic considerations of cardiovascular irAEs while providing real-world examples and perspectives. Recent real-world cases and emerging evidence suggest myocarditis is the most common and potentially fatal cardiovascular irAE, often presenting with symptoms such as shortness of breath or chest pain within weeks of therapy initiation. Other cardiotoxic effects include arrhythmias such as tachyarrhythmias or conduction blocks, heart failure, takotsubo cardiomyopathy, and pericardial disease, sometimes with pericardial effusion. These events can be severe, requiring prompt recognition and intervention to avoid deterioration. Diagnosis typically involves surveillance, a high index of suspicion, biomarker elevations, imaging modalities, cardiac magnetic resonance, and in select cases, endomyocardial biopsy. Early cessation of immunotherapy and high-dose corticosteroids frequently help stabilize acutely ill patients with additional immunomodulators such as intravenous immunoglobulin or abatacept considered in steroid-refractory cases. Clinicians are urged to adopt a multidisciplinary approach involving close cardiology collaboration for baseline risk evaluation, structured surveillance, and cautious rechallenge decisions. Despite these challenges, immunotherapy remains vital for the management of many malignancies. Ongoing research into targeted immunomodulation, refined imaging protocols, and genetic profiling may enhance clinical outcomes by enabling prevention, earlier detection and safer management of cardiovascular irAEs.