Cardiovascular Effects of Immune Checkpoint Inhibitors: More Than Just Myocarditis

Curr Oncol Rep. 2023 Jul;25(7):743-751. doi: 10.1007/s11912-023-01411-7. Epub 2023 Apr 5.

Abstract

Purpose of review: Immune checkpoint inhibitors have reshaped the treatment of cancer, but they are characterized by peculiar toxicity consisting of immune-related adverse events that may potentially affect any organ or system. In this review, we summarize data on clinical presentation, diagnosis, pathogenesis, and management of the main immune-related cardiovascular toxicities of immune checkpoint inhibitors.

Recent findings: The most relevant immune-related cardiovascular toxicity is myocarditis, but other non-negligible reported events include non-inflammatory heart failure, conduction abnormalities, pericardial disease, and vasculitis. More recently, growing evidence suggests a role for immune checkpoint inhibitors in accelerating atherosclerosis and promoting plaque inflammation, thus leading to myocardial infarction. Immune checkpoint inhibitors are associated with several forms of cardiovascular toxicity; thus, an accurate cardiovascular baseline evaluation and periodical monitoring are required. Furthermore, the optimization of cardiovascular risk factors before, during, and after treatment may contribute to mitigating both short-term and long-term cardiovascular toxicity of these drugs.

Keywords: Atherosclerosis; Conduction disease; Immunotherapy; Myocardial infarction; Myocarditis; Pericardial disease.

Publication types

  • Review

MeSH terms

  • Heart
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects
  • Immunotherapy / adverse effects
  • Myocarditis* / chemically induced
  • Myocarditis* / diagnosis
  • Neoplasms* / complications
  • Neoplasms* / drug therapy

Substances

  • Immune Checkpoint Inhibitors