Cardiac Toxicities of Immune Checkpoint Inhibitors: MoreAwareness is Needed

Abstract

Immune checkpoints inhibitors (ipilimumab, nivolumab, pembrolizumab, cemiplimab, atezolizumab, avelumab, durvalumab) are monoclonal antibodies that target cell membrane receptors (CTLA-4, PD-1, PDL-1) implicated in the immunosuppression. This results in activation of the lymphocytic immune response leading to CD8+ T cells proliferation in many organs including the heart. However, the management consists of stopping the immunotherapy and starting high-dose corticosteroids. The incidence of these toxicities as well as their pathophysiology, risk factors, onset and prognosis are not clearly established yet due to the lack of data and cohort studies. Despite the FDA approval of these drugs in the treatment of many refractory cancers, they shouldbe used with caution due to their devastating repercussions.