Cardiovascular Toxicity of Immune Checkpoint Inhibitors: A Guide for Clinicians

Drug Saf. 2023 Sep;46(9):819-833. doi: 10.1007/s40264-023-01320-5. Epub 2023 Jun 21.

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment and care of patients with cancer owing to unique features, including the occurrence of the so-called immune-related adverse events (irAEs). A multidisciplinary team, possibly including a cardio-oncology specialist, is warranted to achieve a favorable patient outcome. Cardiovascular toxicity, especially myocarditis, emerged as a life-threatening irAE in the real-word setting, and the European Society of Cardiology has recently published the first guideline on cardio-oncology to increase awareness and promote a standardized approach to tackle this complex multimodal issue, including diagnostic challenges, assessment, treatment, and surveillance of patients with cancer receiving ICIs. In this article, through a question & answer format made up of case vignettes, we offer a clinically oriented overview on the latest advancements of ICI-related cardiovascular toxicity, focusing on myocarditis and associated irAEs (myositis and myasthenia gravis within the so-called overlap syndrome), with the purpose of assisting clinicians and healthcare professionals in daily clinical practice.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents, Immunological* / adverse effects
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects
  • Medical Oncology
  • Myocarditis* / chemically induced
  • Myocarditis* / diagnosis
  • Myocarditis* / drug therapy
  • Neoplasms* / drug therapy

Substances

  • Immune Checkpoint Inhibitors
  • Antineoplastic Agents, Immunological