How can we manage the cardiac toxicity of immune checkpoint inhibitors?
Remo PotoGiancarlo MaroneFlora PirozziMaria Rosaria GaldieroAlessandra CuomoLuigi FormisanoRoberto BiancoCarminia Maria Della CorteFloriana MorgilloStefania NapolitanoTeresa TroianiCarlo Gabriele TocchettiValentina MercurioGilda VarricchiPublished in: Expert opinion on drug safety (2021)
Introduction: Cancer immunotherapies with monoclonal antibodies (mAbs) against immune checkpoints (i.e. CTLA-4 and PD-1/PD-L1) have revolutionized antineoplastic treatments. Immune checkpoint inhibitors (ICIs) approved for cancer immunotherapy are mAbs anti-CTLA-4 (ipilimumab), anti-PD-1 (nivolumab, pembrolizumab, and cemiplimab), and anti-PD-L1 (atezolizumab, avelumab, and durvalumab). Treatment with ICIs can be associated with immune-related adverse events (irAEs), including an increased risk of developing myocarditis. These findings are compatible with the observation that, CTLA-4, PD-1, and PD-L1 pathways play a central role in the modulation of autoimmunity.Areas covered: In this paper, we start from examining the pathogenesis of cardiovascular adverse events from ICIs, and then we focus on risk factors and strategies to prevent and manage this cardiotoxicity.Expert opinion: There is a growing need for a multidisciplinary approach of ICI-associated cardiotoxicity, involving oncologists, cardiologists, and immunologists. Prevention and effective management of ICIs cardiotoxicity starts with an in-depth screening and surveillance strategies of high-risk patients, in order to improve early detection and appropriate management in a personalized approach.
Keyphrases
- risk factors
- end stage renal disease
- ejection fraction
- chronic kidney disease
- newly diagnosed
- public health
- papillary thyroid
- peritoneal dialysis
- left ventricular
- optical coherence tomography
- heart failure
- patient reported outcomes
- advanced non small cell lung cancer
- squamous cell carcinoma
- squamous cell
- patient reported
- combination therapy
- young adults
- celiac disease
- advanced cancer