Cardiovascular toxicity of immune therapies for cancer

• Published in: BMJ (Online) Vol. 385; p. e075859
• Main Authors: Palaskas, Nicolas L, Ali, Hyeon-Ju, Koutroumpakis, Efstratios, Ganatra, Sarju, Deswal, Anita
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 15.05.2024; BMJ Publishing Group LTD
• Subjects: Antigens; Arteriosclerosis; Cancer; Cancer therapies; Cardiac arrhythmia; Cardiotoxicity; Cardiotoxicity - etiology; Cardiovascular Diseases - chemically induced; Cardiovascular system; Cell therapy; Chemoradiotherapy; Chimeric antigen receptors; Clinical Review; Congestive heart failure; Cytokine Release Syndrome - etiology; Cytotoxicity; FDA approval; Heart diseases; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; Immunotherapy; Immunotherapy, Adoptive - adverse effects; Immunotherapy, Adoptive - methods; Low income groups; Lymphocytes; Lymphocytes T; Medical prognosis; Myasthenia gravis; Myocardial infarction; Myocarditis; Myocarditis - chemically induced; Myocarditis - therapy; Neoplasms - drug therapy; Neoplasms - therapy; Pericarditis; Pericarditis - chemically induced; Pericarditis - therapy; Pharmacovigilance; T cell receptors; Thromboembolism; Toxicity; Vasculitis; United States > US
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj-2023-075859

ABSTRACTIn addition to conventional chemoradiation and targeted cancer therapy, the use of immune based therapies, specifically immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T cell therapy (CAR-T), has increased exponentially across a wide spectrum of cancers. This has been paralleled by recognition of off-target immune related adverse events that can affect almost any organ system including the cardiovascular system. The use of ICIs has been associated with myocarditis, a less common but highly fatal adverse effect, pericarditis and pericardial effusions, vasculitis, thromboembolism, and potentially accelerated atherosclerosis. CAR-T resulting in a systemic cytokine release syndrome has been associated with myriad cardiovascular consequences including arrhythmias, myocardial infarction, and heart failure. This review summarizes the current state of knowledge regarding adverse cardiovascular effects associated with ICIs and CAR-T.