Cardiotoxicity Related to Immune Checkpoint Inhibitors
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(2021) 23:4
Cardio-oncology (M Fradley, Section Editor)
Cardiotoxicity Related to Immune Checkpoint Inhibitors StO˜phane Ederhy, MD1,2,* Iris Benhamou-Tarallo, MD1 Marion Chauvet-Droit, MD1 Pascal Nhan, MD1 Raphael Cohen, MD1 Bruno Pinna, MD2,3 Clement Cholet, MD1 Charlotte Fenioux, MD2,3 Stephane Champiat, MD, PhD4 Joe-Elie Salem, MD, PhD2,3,5 Laurie Soulat-Dufour, MD1,6 Ariel A. Cohen, MD, PhD1,2,6 Address *,1 Department of Cardiology, AP-HP, Saint-Antoine Hospital, Sorbonne Université, Paris, France Email: [email protected] 2 UNICO-GRECO APHP.Sorbonne Cardio-Oncology Program, Sorbonne Université, Paris, France 3 INSERM CIC-1901, AP-HP.Sorbonne, Department of Pharmacology, PitiéSalpêtrière Hospital, Sorbonne Université, Paris, France 4 SITEP, Institut Gustave Roussy, Villejuif, France 5 Division of Medicine and Pharmacology, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA 6 Unité INSERM UMRS-ICAN 1166, Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, F-75013, Sorbonne Universités, Paris, France
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Cardio-oncology Keywords Myocarditis I Immune checkpoint inhibitor I Cardiotoxicity I Cancer
Abstract Purpose of review Immune checkpoint inhibitors (ICI) have modified the management of patients with cancer. Their administration is associated with an increased risk of toxicities
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Curr Treat Options Cardio Med
(2021) 23:4
that can affect every organ. Cardiovascular toxicities, particularly myocarditis, can occur with a low incidence (G 1%) in patients treated with ICI, but with a high fatality rate (30– 50%). In this review, we discuss the mechanisms, diagnostic work-up, and management of cardiovascular toxicities associated with ICI. Recent findings The main mechanisms of ICI-related myocarditis were first described in 2016 and are due to an infiltrate comprised T cells positive for CD3+, CD4+, and CD8+ and macrophages positive for CD68. The diagnosis of ICI-associated myocarditis remains challenging and is made on the combination of a clinical syndrome, an electrocardiogram (ECG), biomarker data, and imaging criteria. In most clinical scenarios, endomyocardial biopsy now plays a pivotal role, and the limitation of CMR in this context should be recognized. Glucocorticoids (oral or intravenous) are the first-line treatment for myocarditis confirmed by CMR and/or endomyocardial biopsy. The management of steroidrefractory myocarditis relies on the initiation of immunosuppressive therapies (ATG, infliximab, mycophenolate mofetil, and/or abatacept). However, the potential role of these drugs should be confirmed in well-designed prospective trials, as none of these strategies has been thoroughly evaluated prospectively. Summary ICI-related myocarditis is an emerging toxicity in patients treated with immunotherapy. The diagnosis should be made promptly since it is associated with a high fatality rate. Cortic
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