Cardiotoxicity Related to Immune Checkpoint Inhibitors

AbstractPurpose of reviewImmune checkpoint inhibitors (ICI) have modified the management of patients with cancer. Their administration is associated with an increased risk of toxicities that can affect every organ. Cardiovascular toxicities, particularly myocarditis, can occur with a low incidence (<  1%) in patients treated with ICI, but with a high fatality rate (30–50%). In this review, we discuss the mechanisms, diagnostic work-up, and management of cardiovascular toxicities associated with ICI.Recent findingsThe main mechanisms of ICI-related myocarditis were first described in 2016 and are due to an infiltrate comprised T cells positive for CD3+, CD4+, and CD8+ and macrophages positive for CD68. The diagnosis of ICI-associated myocarditis remains challenging and is made on the combination of a clinical syndrome, an electrocardiogram (ECG), biomarker data, and imaging criteria. In most clinical scenarios, endomyocardial biopsy now plays a pivotal role, and the limitation of CMR in this context should be recognized. Glucocorticoids (oral or intravenous) are the first-line treatment for myocarditis confirmed by CMR and/or endomyocardial biopsy. The management of steroid-refractory myocarditis relies on the initiation of immunosuppressive therapies (ATG, infliximab, mycophenolate mofetil, and/or abatacept). However, the potential role of these drugs should be confirmed in well-designed prospective trials, as none of these strategies has been thoroughly evaluated pros...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research