Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: A Systematic Review
Immune checkpoint inhibitors are immune stimulatory drugs used to treat many types of cancer. These drugs are antibodies against inhibitory proteins, such as CTLA-4 and PD-1/PD-L1, that are expressed on immune cells. When bound, they allow for increased stimulation of T cells to fight tumor cells. H...
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description | Immune checkpoint inhibitors are immune stimulatory drugs used to treat many types of cancer. These drugs are antibodies against inhibitory proteins, such as CTLA-4 and PD-1/PD-L1, that are expressed on immune cells. When bound, they allow for increased stimulation of T cells to fight tumor cells. However, immune checkpoint inhibitors have several immune-related adverse effects. Many cases have come to light recently of cardiotoxicity as a result of treatment with these drugs. Cardiotoxicity from immune checkpoint inhibitors is unique due to its rarity and high mortality rate. Patients with this toxicity may present with myocarditis, pericarditis, Takotsubo cardiomyopathy, conduction disorders, and others within just a few weeks of starting immune checkpoint inhibitors. We present here a review of the current research on immune checkpoint inhibitors, their associated cardiotoxicities, the timing of presentation of these conditions, lab tests and histology for each condition, and finally the treatment of patients with cardiotoxicity. We observe a positive skew in the onset of presentation, which is significant for the treating physician. |
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These drugs are antibodies against inhibitory proteins, such as CTLA-4 and PD-1/PD-L1, that are expressed on immune cells. When bound, they allow for increased stimulation of T cells to fight tumor cells. However, immune checkpoint inhibitors have several immune-related adverse effects. Many cases have come to light recently of cardiotoxicity as a result of treatment with these drugs. Cardiotoxicity from immune checkpoint inhibitors is unique due to its rarity and high mortality rate. Patients with this toxicity may present with myocarditis, pericarditis, Takotsubo cardiomyopathy, conduction disorders, and others within just a few weeks of starting immune checkpoint inhibitors. We present here a review of the current research on immune checkpoint inhibitors, their associated cardiotoxicities, the timing of presentation of these conditions, lab tests and histology for each condition, and finally the treatment of patients with cardiotoxicity. We observe a positive skew in the onset of presentation, which is significant for the treating physician.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers13205218</identifier><identifier>PMID: 34680365</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Antibodies ; Antidotes ; Antigens ; Cancer ; Cancer therapies ; Cardiomyocytes ; Cardiomyopathy ; Cardiotoxicity ; Cell cycle ; Cell death ; COVID-19 ; CTLA-4 protein ; Cytotoxicity ; Heart diseases ; Heart failure ; Immune checkpoint inhibitors ; Immune system ; Immunosuppressive agents ; Inflammation ; Ischemia ; Lymphocytes ; Lymphocytes T ; Myocarditis ; Patients ; PD-1 protein ; PD-L1 protein ; Pericarditis ; Smooth muscle ; Systematic Review ; Tumor cells ; Tumors</subject><ispartof>Cancers, 2021-10, Vol.13 (20), p.5218</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). 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subjects | Antibodies Antidotes Antigens Cancer Cancer therapies Cardiomyocytes Cardiomyopathy Cardiotoxicity Cell cycle Cell death COVID-19 CTLA-4 protein Cytotoxicity Heart diseases Heart failure Immune checkpoint inhibitors Immune system Immunosuppressive agents Inflammation Ischemia Lymphocytes Lymphocytes T Myocarditis Patients PD-1 protein PD-L1 protein Pericarditis Smooth muscle Systematic Review Tumor cells Tumors |
title | Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: A Systematic Review |
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