Key result
Immune checkpoint inhibitors, specifically CTLA-4 and PD-1 inhibitors, are associated with severe cardiotoxicity including fulminant myocarditis and fatal heart failure.
Why the study?
While cardiotoxicity was underestimated initially, reports of fulminant myocarditis and fatal HF have emerged with immune checkpoint inhibitor therapy.
What are the mechanisms and clinical implications of cardiotoxicity associated with immune checkpoint inhibitors in cancer patients?
What are the mechanisms and clinical implications of cardiotoxicity associated with immune checkpoint inhibitors in cancer patients?
Highlights the emerging risk of severe cardiotoxicity, including fulminant myocarditis and heart failure, associated with immune checkpoint inhibitors, emphasizing the need for cardio-oncology collaboration.
Clinicians should monitor for fulminant myocarditis and HF with ICIs; review leaves optimal screening and management open.
The introduction of immune checkpoint inhibitors have greatly improved clinical outcomes in several cancer types, revolutionizing the management of a wide variety of tumors endowed with poor prognosis. Despite its success, high grade immune related adverse events were observed in patients treated with checkpoint inhibitors. While cardiotoxicity was largely underestimated in initial studies, numerous reports of fulminant myocarditis and fatal heart failure (HF) have been recently described. In this review we discuss possible mechanisms involved in cardiac toxicity triggered by inhibition of cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) pathway, the most prominent checkpoint inhibitors available in the clinic. Major cardiovascular events associated with checkpoint inhibitors adds another layer of complexity in cancer therapy and urges for an interdisciplinary approach between oncologists, cardiologists, and immunologist.
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Delgobo et al. (2018) conducted a review in Cancer and checkpoint inhibitor-induced cardiotoxicity. Immune checkpoint inhibitors (CTLA-4 and PD-1 inhibitors) was evaluated. Immune checkpoint inhibitors, specifically CTLA-4 and PD-1 inhibitors, are associated with severe cardiotoxicity including fulminant myocarditis and fatal heart failure.
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