Cardiac Toxicities Associated with Immune Checkpoints Inhibitors: Mechanisms, Manifestations and Management

Abdulrazzak Zarifa; Jin Wan Kim; Juan Lopez-Mattei; Nicolas Palaskas; Cezar Iliescu; Peter Y Kim

doi:10.4070/kcj.2021.0089

Cardiac Toxicities Associated with Immune Checkpoints Inhibitors: Mechanisms, Manifestations and Management

Korean Circ J. 2021 Jul;51(7):579-597. doi: 10.4070/kcj.2021.0089.

Authors

Abdulrazzak Zarifa^#¹, Jin Wan Kim^#², Juan Lopez-Mattei³, Nicolas Palaskas³, Cezar Iliescu³, Peter Y Kim⁴

Affiliations

¹ Department of Medicine, Brookdale Hospital University and Medical Center, Brooklyn, NY, USA.
² Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
³ Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. pkim@mdanderson.org.

^# Contributed equally.

Abstract

Immune checkpoint inhibitor (ICI) associated cardiovascular adverse events (CVAE) have become more frequent with the growing use of cancer immunotherapy. CVAEs include a wide spectrum of diseases such as myocarditis, pericarditis, heart failure, arrhythmias, coronary artery disease, and hypertension. The induction of cardiovascular side effects by ICI use is hypothesized to occur due to inflammation and immune dysregulation of normal tissue in response to immunotherapy. Management of ICI-associated CVAEs mitigates an overactive immune response by utilizing steroids, immunomodulatory drugs and hemodynamic stabilization. However, few controlled studies on the cardiovascular safety of ICIs exist and treatment of their side effects are mostly from limited case series. Our review seeks to provide the most recent understanding of ICI-associated CVAEs and their management.

Keywords: CTLA-4; Immune checkpoint inhibitor; Myocarditis; PD-1; PD-L1.

Publication types

Review