Cardiovascular Complications of Novel Anti-Cancer Immunotherapy: Old Problems from New Agents?

Abstract

Many novel anti-cancer therapies have dramatically improved outcomes of various cancer patients. However, it also poses a risk for cardiovascular complications as well. For the novel anti-cancer agent with which physicians does not have enough clinical experiences to determine the characteristics of cardiovascular complications, it is important to assess risk factors for cardiotoxicity before starting anti-cancer therapy. High-risk patient should be consulted to cardiologist before initiating anti-cancer therapy and pre-emptive cardiac function monitoring plan might be prepared in advance. The biomarkers, electrocardiography and echocardiography are useful tools for the detection of subclinical cardiotoxicity during anti-cancer therapy. This review article tried to suggest the cardiac function monitoring strategies for newly encountered potential cardiotoxic anti-cancer agents and to summarize the cardiovascular complications of novel anti-cancer immunotherapies including immune checkpoint inhibitor (ICI) and chimeric antigen receptor (CAR) T-cell therapy. ICIs can cause fatal myocarditis, which usually occurs early after initiation, and prompt treatment with high-dose corticosteroid is necessary. CAR T-cell therapy can cause cytokine release syndrome, which may result in circulatory collapse. Supportive treatment as well as tocilizumab, an anti-interleukin-6 receptor antibody are cornerstones of treatment.

Characteristics and outcomes of heart transplant recipients with a pretransplant history of malignancy

“…10,18,19 The number of patients with prior malignancy needing HTx is also increasing due to increased numbers of cancer survivors and cardiotoxic cancer treatment. [12][13][14][15][16][17][18][19] Recent registry data from the United Network for Organ Sharing (UNOS) revealed that early survival of patients with PTM was poorer driven by increased mortality for patients with hematologic PTM, but mortality at 5 year of PTM was comparable between those with and without PTM. 23 However, detailed clinical characteristics and comprehensive outcomes including CAV, NF-MACE, ATR, ACR, and AMR have not been investigated.…”

“…Aging population and improved cancer treatment have resulted in a growing number of cancer survivors. 10,18,19 The number of patients with prior malignancy needing HTx is also increasing due to increased numbers of cancer survivors and cardiotoxic cancer treatment. [12][13][14][15][16][17][18][19] Recent registry data from the United Network for Organ Sharing (UNOS) revealed that early survival of patients with PTM was poorer driven by increased mortality for patients with hematologic PTM, but mortality at 5 year of PTM was comparable between those with and without PTM.…”

“…A history of pretransplant malignancy (PTM) has been considered as a relative contraindication for HTx because of the potential for recurrence or de novo malignancy development with immunosuppression, which may impact on post HTx survival 2–10 . However, the number of patients with prior malignancy needing HTx is increasing due to improved cancer survival and increasing numbers of effective, yet cardiotoxic cancer treatment regimen 11–21 . The adult heart recipient characteristics for the most recent era (2010 to June 2018) showed that 8.6% had a history of PTM 22 .…”

Heart Transplant Immunosuppression Strategies at Cedars-Sinai Medical Center

“…Significant advances in immunotherapies have been made in the treatment of malignancy. 52) 53) As malignancy remains the major limitation to long term longevity after solid organ transplant, 54) if immunotherapy used for treatment of malignancy can cross over and be used in maintenance immunosuppression post-transplant, there is hope that limited lifespan due to malignancy will be addressed.…”

Anticancer Drug-Induced Cardiotoxicity: Insights and Pharmacogenetics

“…However, it has been documented that all of these factors collectively lead to congestive heart failure and sudden cardiac death. Table 1 summarizes the adverse cardiotoxic consequences of chemotherapy [ 114 ].…”