Heart Vessels and Transplantation (Apr 2024)

Cardiotoxicity of checkpoint inhibitors: focus on immune side effects

  • Yuri I. Buziashvili,
  • Elmira U. Asymbekova,
  • Elvina F. Tugeeva ,
  • Elena V. Artamonova ,
  • Firdavsjon R. Akiljonov

DOI
https://doi.org/10.24969/hvt.2024.480
Journal volume & issue
Vol. 8, no. 2

Abstract

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Objective: The use of checkpoint inhibitors in cancer will continue to expand in the coming years, which is a promising area for future clinical research. However, diagnosis of immune-related side effects is challenging due to its heterogeneous clinical manifestations, which range from subclinical to fulminant manifestations with high in-hospital mortality. A potential mechanism may be proliferation and clonal expansion of antigens by T lymphocytes in tumor cells and affected self-tissues. The exact pathophysiological mechanism remains unclear and the risk profile of patients experiencing cardiotoxicity is unknown. The aim of our work is to focus on the immune side effects of immunotherapy and their mechanisms. Methods: We used PubMed (Medline) database, Google Scholar for evidence search. The search depth was up to 10 years. The search phrases used were: “immune side effects”, “cardiotoxicity of immunotherapy”, “checkpoint inhibitors”. Search result by keywords in the PubMed (Medline) database, Google Scholar found a total of 205 publications. Number publications after removing duplicates amounted to 165. After analyzing the titles and their abstracts, 40 publications met the goal, 17 publications passed the full-text screening. Thus, our review finally included 13 studies. Results: Immune checkpoint inhibitors are the most notable breakthrough in the treatment of cancer, but the wide range of adverse events associated with the immune system should not be ignored. According to the analysis of the studies cardiac adverse are reported in 13.3% of patients receiving such therapy, myocarditis – 2.1% and cardiac arrhythmias – 9%, other cardiovascular pathology is rare. The exact pathophysiological mechanism remains unclear and the risk profile of patients experiencing cardiotoxicity is unknown. Conclusion: Continued intensive efforts by the research communities and interdisciplinary collaborations in oncology and cardiology will help address these challenges and thereby allow immunotherapy to achieve its maximum potential benefit in the treatment of cancer.

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