Managing cardiotoxicity associated with immune checkpoint inhibitors

Sireesha Upadhrasta; Hadi Elias; Keval Patel; Lei Zheng

doi:10.1016/j.cdtm.2019.02.004

Managing cardiotoxicity associated with immune checkpoint inhibitors

Chronic Dis Transl Med. 2019 Mar 21;5(1):6-14. doi: 10.1016/j.cdtm.2019.02.004. eCollection 2019 Mar.

Authors

Sireesha Upadhrasta¹, Hadi Elias¹, Keval Patel², Lei Zheng³

Affiliations

¹ Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD 21229, USA.
² Department of Internal Medicine, University of Maryland, Baltimore, MD 21201, USA.
³ Departments of Oncology and Surgery, The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, MD 21287, USA.

Abstract

Immuno-oncology is a fast evolving field of cancer therapy and immune checkpoint inhibitors (ICIs) are clearly a breakthrough in this field. Cardiotoxicity with conventional anti-cancer therapies has been well studied in the past and clear guidelines for management of these side effects are available in the literature. However, cardiotoxicity with novel agents such as ICIs has been fairly under-reported and/or underestimated and we are yet to formulate clear guidelines for management of these rare side effects. In the last few years, there has been an overall increase in the number of cases of cardiotoxicity related to ICIs. In this literature review, we describe the mechanism of action of the most widely used ICIs and their related cardiotoxicities. The increase in number of case reports about the potential of cardiotoxicities with these novel agents clearly indicates the need for a new insight into the field of cardio-immuno-oncology.

Keywords: Cardiotoxicity; Immune checkpoint inhibitor; Ipilimumab; Nivolumab; Pembrolizumab.