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Cardiovasc Res. 2019 Apr 15;115(5):854-868. doi: 10.1093/cvr/cvz026.

Cardiovascular toxicities associated with immune checkpoint inhibitors.

Author information

1
Division of Cardiology, Cardio-Oncology Program, Vanderbilt University Medical Center, 2220 Pierce Avenue, Nashville, USA.
2
Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, USA.
3
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, USA.
4
Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, USA.
5
Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E Young Dr S, Los Angeles, CA, USA.
6
Department of Translational Medical Sciences, Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Via Pansini 5, Naples, NA, Italy.
7
Cardio-Oncology Service, Royal Brompton Hospital, Dovehouse St, London, UK.
8
National Heart and Lung Institute, Imperial College London, Sydney Street, London, UK.
9
Department of Pathology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA.
10
Division of Hematology-Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, Nashville, TN, USA.

Abstract

Cardiovascular toxicities associated with immune checkpoint inhibitors (ICIs) have been reported in case series but have been underappreciated due to their recent emergence, difficulties in diagnosis and non-specific clinical manifestations. ICIs are antibodies that block negative regulators of the T cell immune response, including cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and PD-1 ligand (PD-L1). While ICIs have introduced a significant mortality benefit in several cancer types, the augmented immune response has led to a range of immune-related toxicities, including cardiovascular toxicity. ICI-associated myocarditis often presents with arrhythmias, may co-exist with myositis and myasthenia gravis, can be severe, and portends a poor prognosis. In addition, pericardial disease, vasculitis, including temporal arteritis, and non-inflammatory heart failure, have been recently described as immune-related toxicities from ICI. This narrative review describes the epidemiology, diagnosis, pathophysiology, and treatment of cardiovascular toxicities of ICI therapy, highlighting recent developments in the field in the past year.

KEYWORDS:

Cardio-oncology; Cardiovascular toxicity; Immune checkpoint inhibitors; Myocarditis; Pericarditis; Vasculitis

PMID:
30715219
PMCID:
PMC6452314
[Available on 2020-04-15]
DOI:
10.1093/cvr/cvz026

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