Cardiac Complications in Immune Checkpoint Inhibition Therapy

• Main Authors: Kazuko Tajiri, Masaki Ieda
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2019-01-01
• Series: Frontiers in Cardiovascular Medicine
• Subjects: immune checkpoint inhibitors; myocarditis; cardiotoxicity; programmed cell death protein 1; cytotoxic T-lymphocyte antigen 4; immune-related adverse events
• Online Access: https://www.frontiersin.org/article/10.3389/fcvm.2019.00003/full

Immune checkpoint inhibitors (ICIs) have changed the treatment landscape of advanced cancers. Unfortunately, these agents can induce a wide spectrum of immune-related adverse events (irAEs) through activation of immune responses in non-target organs, including the heart. As the clinical use of ICI therapy increases rapidly, management of irAEs is becoming extremely important. The most commonly presented cardiac irAE is myocarditis. Histopathologically, T-cell (with a predominance of CD8+ cells) and macrophage infiltration in the myocardium is typically observed in ICI-associated myocarditis. Other presentations of cardiac irAEs include congestive heart failure, Takotsubo cardiomyopathy, pericardial disease, arrhythmias, and conduction disease. Although cardiac irAEs are relatively rare, they can be life-threatening. Hence, cardiologists and oncologists should be vigilant for these presentations.