Immune Checkpoint Inhibitors and the Heart

Mocan-Hognogi, Diana Larisa; Trancă, Sebastian; Fărcăş, Anca Daniela; Mocan-Hognogi, Radu Florin; Pârvu, Andrada; Bojan, Anca

doi:10.3389/fcvm.2021.726426

Cited by 12 publications

(5 citation statements)

References 65 publications

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“…To the best of our knowledge, this is the first systematic review specifically designed to retrieve published cases of cancer patients treated with ICIs that developed TTS. Other reviews on the topic have investigated either the impact of anticancer agents to the development of TTS [11,32,34] or the overall cardiotoxic effect of ICIs [5,[35][36][37][38][39]. Our systematic search and study design allowed us to retrieve 17 cases, the most reports recruited up to date in the literature, and to meticulously describe several TTS characteristics.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Summary of Included Cases

Trontzas,

Vathiotis,

Kyriakoulis

et al. 2023

Cancers

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Background: There are emerging reports of Takotsubo syndrome (TTS) in cancer patients treated with immune checkpoint inhibitors (ICIs); however, the association of the two remains uncertain. Methods: A systematic literature review was performed in the PubMed database and web sources (Google Scholar) according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Case reports/series or studies including cancer patients treated with ICIs and presenting with TTS were considered. Results: Seventeen cases were included in the systematic review. Most patients were males (59%) with median age of 70 years (30–83). Most common tumor types were lung cancer (35%) and melanoma (29%). Most patients were on first-line immunotherapy (35%) and after the first cycle (54%) of treatment. The median time on immunotherapy at the time of TTS presentation was 77 days (1–450). The most used agents were pembrolizumab and the combination of nivolumab–ipilimumab (35%, respectively). Potential stressors were recognized in 12 cases (80%). Six patients (35%) presented with concurrent cardiac complications. Corticosteroids were used in the management of eight patients (50%). Fifteen patients (88%) recovered from TTS, two patients (12%) relapsed, and one patient died. Immunotherapy was reintroduced in five cases (50%). Conclusion: TTS may be associated with immunotherapy for cancer. Physicians should be alert for TTS diagnosis in any patient with myocardial infarction-like presentation under treatment with ICIs.

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Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Summary of Included Cases

Trontzas,

Vathiotis,

Kyriakoulis

et al. 2023

Cancers

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“…Tumor-intrinsic factors partook of the tumor-extrinsic mechanisms of ICIs-related cardiotoxicity through their effect on the interaction between the host immune system and the tumor [ 92 , 96 ]. The interval of time required for cardiotoxicity to occur has not yet been precisely indicated [ 97 , 98 ], so further work is required to elucidate this. There are still many unanswered questions about the effect of patient-intrinsic factors on ICIs-related cardiotoxicity because the mechanisms differ, even in patients treated with the same agent.…”

Section: Discussionmentioning

confidence: 99%

ICIs-Related Cardiotoxicity in Different Types of Cancer

Dong

Zhang

et al. 2022

JCDD

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Immune checkpoint inhibitors (ICIs) are rapidly developing immunotherapy cancer drugs that have prolonged patient survival. However, ICIs-related cardiotoxicity has been recognized as a rare, but fatal, consequence. Although there has been extensive research based on different types of ICIs, these studies have not indicated whether cardiotoxicity is specific to a type of cancer. Therefore, we conducted a systematic review to analyze a variety of ICIs-related cardiotoxicity, focusing on different types of cancer. We found that the incidence of ICIs-related cardiac adverse events (CAEs) and common cardiotoxic manifestations vary with cancer type. This inspired us to explore the underlying mechanisms to formulate targeted clinical strategies for maintaining the cardiovascular health of cancer patients.

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“…93 The 2017 consensus statement of the Society for Immunotherapy of Cancer’s Toxicity Management Working Group recommended permanent discontinuation of ICIs in patients with cardiotoxicity grade 4; however; it suggests a rechallenge in stabilized patients with grade 3 cardiotoxicity. 94,95…”

Section: Management Of Ici-associated Cardiotoxicitymentioning

confidence: 99%

Cardiovascular Toxicity Associated With Immune Checkpoint Inhibitor Therapy: A Comprehensive Review

Chitsazan

Amin

Ladel

et al. 2023

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Immune checkpoint inhibitors (ICIs), a significant breakthrough treatment of cancer, exert their function through enhancing the immune system’s ability to recognize and attack cancer cells. However, these revolutionary cancer treatments have been associated with a range of immune-related adverse effects, including cardiovascular toxicity. The most commonly reported cardiovascular toxicities associated with ICIs are myocarditis, pericarditis, arrhythmias, and vasculitis. These cardiovascular manifestations are often severe and can lead to life-threatening complications. Therefore, prompt identification and management of these toxicities is critical, and a multidisciplinary teamwork by cardiologists and oncologists are required to ensure optimal patient outcomes. In this review, we summarize the current knowledge on the mechanisms underlying ICI-associated cardiovascular toxicity, clinical presentations of these toxicities, potential risk factors, diagnosis, management, and surveillance strategies during ICI therapy. While ICIs have already transformed cancer treatment, further research is needed to better understand and manage their immune-related cardiovascular effects, and possibly, to identify biomarkers which can predict the occurrence of these cardiovascular complications.

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Immune Checkpoint Inhibitors and the Heart

Cited by 12 publications

References 65 publications

Takotsubo Cardiomyopathy in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Summary of Included Cases

Takotsubo Cardiomyopathy in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Summary of Included Cases

ICIs-Related Cardiotoxicity in Different Types of Cancer

Cardiovascular Toxicity Associated With Immune Checkpoint Inhibitor Therapy: A Comprehensive Review

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