Cardiovascular Toxicities of Immune Checkpoint Inhibitors

Ball, Somedeb; Ghosh, Raktim; Wongsaengsak, Sariya; Bandyopadhyay, Dhrubajyoti; Ghosh, Gopal Chandra; Aronow, Wilbert S.; Fonarow, Gregg C.; Lenihan, Daniel J.; Bhatt, Deepak L.

doi:10.1016/j.jacc.2019.07.079

Cited by 137 publications

(150 citation statements)

References 53 publications

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“…The growing clinical use of immune checkpoint inhibitors (ICI) has increased our knowledge on the immune-related adverse events (IRAE) affecting the cardiovascular system. 1 Myocarditis, arrhythmia, and cardiomyopathy are the most frequently described cardiovascular IRAE, affecting 1%-1.5% of the patients that receive ICI therapy. 1 The increased awareness of cardiovascular IRAE stimulates initiatives to improve the care for cancer patients who develop these toxicities, such as practice guidelines, clinical cardio-oncology programs, clinical registries, and the launch of focused scientific journals.…”

Section: Introductionmentioning

confidence: 99%

“…1 Myocarditis, arrhythmia, and cardiomyopathy are the most frequently described cardiovascular IRAE, affecting 1%-1.5% of the patients that receive ICI therapy. 1 The increased awareness of cardiovascular IRAE stimulates initiatives to improve the care for cancer patients who develop these toxicities, such as practice guidelines, clinical cardio-oncology programs, clinical registries, and the launch of focused scientific journals. 1 These important initiatives will undoubtedly increase our knowledge on cardiovascular IRAE and stimulate the development of evidence-based treatment strategies for these potentially lethal complications.…”

Section: Introductionmentioning

confidence: 99%

“…1 The increased awareness of cardiovascular IRAE stimulates initiatives to improve the care for cancer patients who develop these toxicities, such as practice guidelines, clinical cardio-oncology programs, clinical registries, and the launch of focused scientific journals. 1 These important initiatives will undoubtedly increase our knowledge on cardiovascular IRAE and stimulate the development of evidence-based treatment strategies for these potentially lethal complications. 1 The effects of ICI on more gradually developing cardiovascular diseases, in particular atherosclerosis, are relatively underexposed in these promising initiatives.…”

Section: Introductionmentioning

confidence: 99%

“…1 These important initiatives will undoubtedly increase our knowledge on cardiovascular IRAE and stimulate the development of evidence-based treatment strategies for these potentially lethal complications. 1 The effects of ICI on more gradually developing cardiovascular diseases, in particular atherosclerosis, are relatively underexposed in these promising initiatives. From a vascular point of view, we would like to discuss some considerations on the effects of ICI on atherosclerosisrelated cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

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Cancer patients receiving immune checkpoint inhibitor therapy are at an increased risk for atherosclerotic cardiovascular disease

Lutgens

Seijkens

2020

J Immunother Cancer

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The widespread clinical use of immune checkpoint inhibitors (ICI) has increased our knowledge on their adverse effects on chronic inflammatory diseases. Atherosclerosis, a low-grade lipid-driven inflammatory disease of the larger arteries, is commonly present in cancer patients. A major concern is the adverse effect of ICI on atherosclerosis-related cardiovascular disease, resulting in cardiovascular events, such as myocardial infarction or ischaemic stroke. The effects of ICI on atherosclerosis in cancer patients are incompletely understood, but it is well known that immune checkpoint proteins orchestrate the inflammatory response underlying atherogenesis. This paper addresses the hypothesis that ICI therapy puts cancer patients at an increased risk for atherosclerosis-related cardiovascular disease, that might only become apparent years after ICI therapy. Until clinical and experimental studies have addressed this hypothesis, optimal cardiovascular risk management in ICI-treated patients is opportune to reduce the occurrence of cardiovascular disease in cancer patients and long-term cancer survivors.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cancer patients receiving immune checkpoint inhibitor therapy are at an increased risk for atherosclerotic cardiovascular disease

Lutgens

Seijkens

2020

J Immunother Cancer

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“…RACVD is a well-known treatment-related toxicity in the field of cardio-oncology (23-25). Other anti-cancer therapies, such as chemotherapy (26-29), targeted therapy (30- 33), and immunotherapy (34)(35)(36), may also induce cardiovascular dysfunctions (37)(38)(39). As a result, when these therapies are prescribed concurrently or sequentially with RT, the risk of RACVD is increased substantially, especially in vulnerable pediatric (40,41) or elderly cancer patients (42,43).…”

Section: Introductionmentioning

confidence: 99%

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Lee

Liu

Hung

et al. 2020

Front. Cardiovasc. Med.

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Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.

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Miscellaneous Cardiac Topics

2022

Practical Cardiovascular Medicine

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Cardiovascular Toxicities of Immune Checkpoint Inhibitors

Cited by 137 publications

References 53 publications

Cancer patients receiving immune checkpoint inhibitor therapy are at an increased risk for atherosclerotic cardiovascular disease

Cancer patients receiving immune checkpoint inhibitor therapy are at an increased risk for atherosclerotic cardiovascular disease

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Miscellaneous Cardiac Topics

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