Cardiotoxicity of Contemporary Anticancer Immunotherapy

Natalie Dal’bo, Rushin Patel, Rohan Parikh, Sachin P. Shah, Avirup Guha, Sourbha S. Dani, Sarju Ganatra

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Purpose of review: Contemporary anticancer immunotherapy, particularly immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell therapy, has changed the landscape of treatment for patients with a variety of malignancies who historically had a poor prognosis. However, both immune checkpoint inhibitors and CAR T cell therapy are associated with serious cardiovascular adverse effects. As immunotherapy evolves to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of its associated cardiotoxicity will be even higher. Recent findings: ICI can cause myocarditis, which usually occurs early after initiation, can be fulminant, and prompt treatment with high-dose corticosteroids is crucial. CAR T cell therapy frequently leads to cytokine release syndrome, which is associated with cardiomyopathy or arrhythmia development and may also result in circulatory collapse. Supportive treatment, as well as tocilizumab, an anti-interleukin-6 receptor antibody, is the cornerstone of treatment. Recent findings suggest that preexisting cardiovascular risk factors and disease may increase the risk of such cardiotoxicity, and prompt recognition, as well as treatment, may favorably alter the outcomes. Summary: ICI and CAR T cell therapy have improved cancer-related outcomes; however, they both are associated with potentially therapy-limiting cardiotoxicity. Cardio-oncologists are required to play an important role in patient selection, pretherapy cardiovascular optimization, and prompt recognition and treatment of cardiotoxicity.
Original languageEnglish (US)
JournalCurrent Treatment Options in Cardiovascular Medicine
Volume22
Issue number12
DOIs
StatePublished - Dec 1 2020

Keywords

  • CAR T cell therapy
  • COVID-19
  • Cardio-oncology
  • Cardiomyopathy
  • Cardiotoxicity
  • Chimeric antigen receptor
  • Cytokine release syndrome
  • ICI
  • Immune checkpoint inhibitor
  • Immunotherapy
  • Myocarditis

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