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Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pharmacol. | doi: 10.3389/fphar.2019.01350

Immune checkpoint inhibitor-associated cardiotoxicity: current understanding on its mechanism, diagnosis and management

  • 1State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
  • 2Department of Dermatology and Venereology, West China Hospital, Sichuan University, China
  • 3Department of Neurosurgery, West China Hospital, Sichuan University, China
  • 4West China School of Medicine and Forensic Medicine, Sichuan University, China
  • 5West China Hospital, Sichuan University, China

Immune checkpoint inhibitors (ICIs) that target cytotoxic T lymphocyte antigen 4, programmed cell death-1, and PD-ligand 1 have revolutionized cancer treatment, achieving unprecedented efficacy in multiple malignancies. ICIs are increasingly being used in early cancer settings and in combination with various other types of therapies, including targeted therapy, radiotherapy, and chemotherapy. However, despite the excellent therapeutic effect of ICIs, these medications typically result in a broad spectrum of toxicity reactions, termed immune-related adverse events (irAEs). Of all irAEs, cardiotoxicity, uncommon but with high mortality, has not been well recognized. Herein, based on previous published reports and current evidence, we summarize the incidence, diagnosis, clinical manifestations, underlying mechanisms, treatments, and outcomes of ICI-associated cardiotoxicity and discuss possible management strategies. A better understanding of these characteristics is critical to managing patients with ICI-associated cardiotoxicity.

Keywords: immune checkpoint inhibitors, cardiotoxicity, Myocarditis, Pericarditis, Cytotoxic T lymphocyte-associated antigen-4, programmed cell death protein 1, Programmed cell death-ligand 1

Received: 11 Aug 2019; Accepted: 24 Oct 2019.

Copyright: © 2019 Zhou, Zhu, Wang, Xie, Chen, Zhang, Xia, Ding and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Prof. Zhenyu Ding, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China, dingzhenyu@scu.edu.cn
Prof. Jiyan Liu, West China Hospital, Sichuan University, Chengdu, China, liujiyan1972@163.com