Key result
Cardiotoxicity from immune checkpoint inhibitors, most frequently myocarditis with a mortality rate up to 50%, typically presents within the first three months of therapy but can be delayed up to two years.
Why the study?
Immune checkpoint inhibitors carry rare but high-mortality cardiotoxicity, prompting a review of current research on associated cardiotoxicities, presentation timing, diagnostics, and management.
What are the clinical presentations, onset timings, and management strategies for cardiotoxicity associated with immune checkpoint inhibitors?
Systematic Review (n=134)
What are the clinical presentations, onset timings, and management strategies for cardiotoxicity associated with immune checkpoint inhibitors?
Answers are grounded in this paper and cite their sources.
Clinicians must maintain high vigilance for ICI-associated cardiotoxicity, particularly highly fatal myocarditis, which usually occurs within the first 3 months of therapy but can present much later.
Immune checkpoint inhibitors are immune stimulatory drugs used to treat many types of cancer. These drugs are antibodies against inhibitory proteins, such as CTLA-4 and PD-1/PD-L1, that are expressed on immune cells. When bound, they allow for increased stimulation of T cells to fight tumor cells. However, immune checkpoint inhibitors have several immune-related adverse effects. Many cases have come to light recently of cardiotoxicity as a result of treatment with these drugs. Cardiotoxicity from immune checkpoint inhibitors is unique due to its rarity and high mortality rate. Patients with this toxicity may present with myocarditis, pericarditis, Takotsubo cardiomyopathy, conduction disorders, and others within just a few weeks of starting immune checkpoint inhibitors. We present here a review of the current research on immune checkpoint inhibitors, their associated cardiotoxicities, the timing of presentation of these conditions, lab tests and histology for each condition, and finally the treatment of patients with cardiotoxicity. We observe a positive skew in the onset of presentation, which is significant for the treating physician.
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Shalata et al. (2021) conducted a systematic review in Immune checkpoint inhibitor-associated cardiotoxicity (n=134). Immune checkpoint inhibitors was evaluated on Types, timing of presentation, and outcomes of ICI-associated cardiotoxicity. Cardiotoxicity from immune checkpoint inhibitors, most frequently myocarditis with a mortality rate up to 50%, typically presents within the first three months of therapy but can be delayed up to two years.
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