Cardiotoxicity of Immune Checkpoint Inhibitors and Chimeric Antigen Receptor T-Cell Therapy

Over the last decade, immunotherapy has transformed oncology, with an ever-expanding list of indications. As with any therapeutic class, these agents are accompanied by adverse events that are increasingly recognized and pose new challenges for patient care expanding the scope of cardio-oncology. Using the PubMed database, this narrative review summarizes the cardiovascular adverse events associated with the most commonly used immunotherapies, immune checkpoint inhibitors (ICIs), with a focus on the mechanisms, epidemiology, diagnosis, treatment, and monitoring of ICI-associated myocarditis. We also review accelerated atherosclerotic disease, heart failure, cardiomyopathy (including stress-induced cardiomyopathy), arrhythmias, and pericardial disease related to ICI therapy. Finally, we outline CAR T-cell therapy associated cardiotoxicity, including cytokine release syndrome.