Adverse cardiac events to monoclonal antibodies used for cancer therapy

Kounis, Nicholas G.; Soufras, George D.; Tsigkas, Grigorios; Hahalis, George

doi:10.4161/onci.27987

Cited by 20 publications

(13 citation statements)

References 14 publications

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“…Rituximab can possibly increase autoimmunity by decreasing immunoregulatory B cells. Rituximab‐specific IgE antibodies and TH2 suggestive of type 1 hypersensitivity have been demonstrated . Other monoclonal antibodies such as bevacizumab and trastuzumab were also associated with cardiac events possibly due to autoimmunity .…”

Section: Immunosuppressive Drugsmentioning

confidence: 99%

“…Rituximab‐specific IgE antibodies and TH2 suggestive of type 1 hypersensitivity have been demonstrated . Other monoclonal antibodies such as bevacizumab and trastuzumab were also associated with cardiac events possibly due to autoimmunity . This conundrum highlights that the role of B cells in allo‐ and autoimmunity is complex, not always unambiguous and sometimes modified by unrecognized conditions.…”

Section: Immunosuppressive Drugsmentioning

confidence: 99%

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Cardiovascular disease after transplantation: an emerging role of the immune system

et al. 2018

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Cardiovascular disease (CVD) after transplantation remains a major concern. Little is known about what drives the increased cardiovascular risk in transplant recipients apart from traditional risk factors. The immune system is involved in the pathogenesis of hypertension, atherosclerosis, and coronary artery disease in the general population. Recently, inhibition of interleukin 1 - β by canakinumab versus placebo decreased the incidence of cardiovascular events. Emerging evidence points to a role of adaptive cellular immunity in the development of CVD. Especially, expansion of pro-inflammatory and antiapoptotic cytotoxic CD4 CD28 T cells is closely associated with incident CVD in various study populations including transplant recipients. The association of cytomegalovirus exposure with increased cardiovascular mortality might be explained by its capacity to upregulate these cytotoxic cells. Also, humoral immunity seems to be relevant for cardiovascular outcome in transplant recipients. Panel-reactive antibodies at baseline and donor-specific antibodies are independently associated with poor cardiovascular outcome after kidney transplantation. Cardiovascular effects of immunosuppressive drugs and statins do not only imply indirect positive or negative effects on traditional cardiovascular risk factors but also intrinsic immunological effects. How immunosuppressive drugs modify atherosclerosis largely remains elusive.

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Section: Immunosuppressive Drugsmentioning

confidence: 99%

Section: Immunosuppressive Drugsmentioning

confidence: 99%

Cardiovascular disease after transplantation: an emerging role of the immune system

et al. 2018

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“…The territorial distribution of the ST changes on ECG and the regional wall motion abnormalities seen on cardiac MRI are consistent with this and may be in keeping with spasm of the circumflex artery. Coronary vasospasm due to hypersensitivity reactions is a recognised phenomenon, Kounis syndrome, 4 and has been reported with monoclonal antibodies, including a case with alemtuzumab in the treatment of cancer. However, it is not possible to be certain about the mechanism, and other causes such as an acute myocarditis are in the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Acute cardiotoxicity associated with alemtuzumab infusion for multiple sclerosis

et al. 2020

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Alemtuzumab infusion is rarely associated with serious cardiac toxicity. We report a case of acute troponin-negative chest pain with dynamic T-wave changes, immediately following first infusion of alemtuzumab in a patient with multiple sclerosis. The chest pain and ECG (electrocardiogram) changes improved with cessation of alemtuzumab and conservative management. The presumed cause was infusion-associated cytokine release, but the precise mechanism is unknown.

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“…Coronary artery spasm and atheromatous plaque rupture occur during an allergic reaction. Three variants are recognized: vaso-spastic allergic angina, allergic myocardial infarction, and stent thrombosis leading to ventricular dysfunction, arrhythmias, acute myocardial infarction, and vasospastic angina pectoris [28]. Diagnosis is based on symptoms of chest pain, ST-elevation and acute MI on EKG, elevated troponins, and wall motion abnormalities on echocardiogram.…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

New Cancer Therapies: Implications for the Perioperative Period

Andrabi

French

Qazilbash

2018

Curr Anesthesiol Rep

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Purpose of Review Cancer is on the rise. Standing on verge of exciting discoveries, research is being translated into therapies that are being widely administered to patients. Providing a hope for cure, where none existed before. This new body of knowledge has come from a better understanding of cancer genetics, molecular and sub molecular behavior, and understanding of cancergenerated cellular environments. These have led to development of immunotherapy and its many sub-genres, improvement and introduction of new radiation technologies, and decreasing toxicities of existing chemotherapies. Recent Findings The purpose of this review is to have a summary look at this huge landscape of cancer therapy. Specially looking at toxicities that an anesthesiologist should be familiar with while providing perioperative care for these patients, complications like tumor lysis syndrome, cytokine release syndromes, Kounis syndrome, myocarditis, encephalopathies, and pituitary failure need to be kept in mind. Summary One should be knowledgeable about these therapies and approach these patients with a high index of suspicion. Anesthesiologists will need to refine preoperative assessment with appropriate testing and intraoperative and postoperative management in collaboration with oncologists, while involving the expertise of internists, cardiologist, and endocrinologists in helping assess and manage these patients in the perioperative period. Keywords Anesthesia assessment in cancer patients. Perioperative implications of cancer therapy. New cancer therapies, side effects, and management in perioperative period. Immunotherapy, mechanism of actions, and side effects. Side effects This article is part of the Topical Collection on Cancer Anesthesia

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Adverse cardiac events to monoclonal antibodies used for cancer therapy

Cited by 20 publications

References 14 publications

Cardiovascular disease after transplantation: an emerging role of the immune system

Cardiovascular disease after transplantation: an emerging role of the immune system

Acute cardiotoxicity associated with alemtuzumab infusion for multiple sclerosis

New Cancer Therapies: Implications for the Perioperative Period

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