Cardiology Letters 2019, 28(6):210-217

Cardiotoxicity induced by immune checkpoint inhibitors used in cancer immunotherapy

Országhová Z Jr.¹, Rečková M^{2, 3}, Jablonická M⁴, Mladosievičová B¹

¹ Oddelenie klinickej patofyziológie, Lekárska fakulta UK Bratislava

² Národného onkologického inštitútu, Bratislava

³ POKO Poprad

⁴ Onkologickej klinika SZU, FNsP F. D. Roosevelta, Banská Bystrica, Slovenská republika

Immunotherapy represents a major advance in the treatment of cancer. Over the last decade it has revolutionized the clinical management of a wide spectrum of solid and haematological malignancies, even those associated with a very poor prognosis. Immune checkpoint inhibitors (CPI) are monoclonal antibodies directed against checkpoints of the immune response: cytotoxic T-lymphocyteassociated-4 (CTLA-4), programmed cell death protein 1 (PD-1) and its ligand (PD-L1). They block inhibitory signals of T-cell activation and enable them to provide an effective antitumor response. However, the increasing use of immune checkpoint inhibitors has exposed a group of immune-related adverse events. Relatively common adverse effects are cutaneous, musculoskeletal, intestinal, endocrine and pulmonary, while cardiovascular, haematological, renal and neurological occur much less frequently. Cardiovascular toxicity of CPI is of particular concern given its impact on morbidity and mortality of cancer patients. A predisposition to this cardiotoxicity might also be associated with preexisting risk factors. A brief summary of current knowledge regarding mechanisms of CPI-induced cardiotoxicity development, its individual forms and the proposed management of immune-mediated myocarditis in the CPI-treated patients is stated herein.

Keywords: immunotherapy; immune checkpoint inhibitors; adverse events; cardiotoxicity; myocarditis

Published: June 1, 2019  Show citation