Cardiovascular toxicities associated with immune checkpoint inhibitors

Jiun Ruey Hu, Roberta Florido, Evan J. Lipson, Jarushka Naidoo, Reza Ardehali, Carlo G. Tocchetti, Alexander R. Lyon, Robert F. Padera, Douglas B. Johnson, Javid Moslehi

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)854-868
Number of pages15
JournalCardiovascular research
Volume115
Issue number5
DOIs
StatePublished - Apr 15 2019

Keywords

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

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Hu, J. R., Florido, R., Lipson, E. J., Naidoo, J., Ardehali, R., Tocchetti, C. G., Lyon, A. R., Padera, R. F., Johnson, D. B., & Moslehi, J. (2019). Cardiovascular toxicities associated with immune checkpoint inhibitors. Cardiovascular research, 115(5), 854-868. https://doi.org/10.1093/cvr/cvz026