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Current Treatment Options in Cardiovascular Medicine

Erschienen in:

01.07.2019 | Cardio-oncology (M Fradley, Section Editor)

Cardiotoxicity of Immune Checkpoint Inhibitors

verfasst von: Lili Zhang, MD, ScM, Maeve Jones-O’Connor, MD, Magid Awadalla, MD, Daniel A. Zlotoff, MD, PhD, Paaladinesh Thavendiranathan, MD, John D. Groarke, MB, BCh, MPH, Alexandra-Chloe Villani, PhD, Alexander R. Lyon, MD, PhD, Tomas G. Neilan, MD, MPH

Erschienen in: Current Treatment Options in Cardiovascular Medicine | Ausgabe 7/2019

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Abstract

Purpose of review

Immunotherapies, particularly immune checkpoint inhibitors (ICI), are revolutionary cancer therapies being increasingly applied to a broader range of cancers. Our understanding of the mechanism, epidemiology, diagnosis, and treatment of cardiotoxicity related to immunotherapies remains limited. We aim to synthesize the limited current literature on cardiotoxicity of ICIs and to share our opinions on the diagnosis and treatment of this condition.

Recent findings

The incidence of ICI-associated myocarditis ranges from 0.1 to 1%. Patients with ICI-associated myocarditis often have a fulminant course with a case fatality rate of 25–50%. The diagnosis of this condition poses many challenges because independently a normal electrocardiogram, biomarkers, or a preserved left ventricular function do not rule out ICI-associated myocarditis. Endomyocardial biopsy should be pursued when clinical suspicion remains despite normal non-invasive tests. Data on optimal screening and surveillance tools are lacking. Cessation of ICIs, combined with high dose corticosteroids and other immunosuppressant approaches are the cornerstones of the treatment of ICI-associated myocarditis. This condition may recur when patients are re-challenged with these agents and the decision to resume ICIs should be made through a multidisciplinary discussion.

Summary

Immunotherapies have changed the landscape of cancer treatment. Recognizing and managing cardiotoxicity related to ICIs is of critical importance. Our understanding of ICI-cardiotoxicity has improved, but large information gaps remain for further research. Due to the high case fatality rate, any type of cardiac symptoms or signs in a patient who has recently started an ICI should prompt consideration of ICI-cardiotoxicity.

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Titel: Cardiotoxicity of Immune Checkpoint Inhibitors
verfasst von: Lili Zhang, MD, ScM
Maeve Jones-O’Connor, MD
Magid Awadalla, MD
Daniel A. Zlotoff, MD, PhD
Paaladinesh Thavendiranathan, MD
John D. Groarke, MB, BCh, MPH
Alexandra-Chloe Villani, PhD
Alexander R. Lyon, MD, PhD
Tomas G. Neilan, MD, MPH
Publikationsdatum: 01.07.2019
Verlag: Springer US
Erschienen in: Current Treatment Options in Cardiovascular Medicine / Ausgabe 7/2019
Print ISSN: 1092-8464
Elektronische ISSN: 1534-3189
DOI: https://doi.org/10.1007/s11936-019-0731-6

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Cardiotoxicity of Immune Checkpoint Inhibitors

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