Cardiotoxicities associated with immune checkpoint inhibitors

This review provides an overview of clinical manifestations, diagnostic approaches, and management strategies for cardiotoxicities associated with the use of immune checkpoint inhibitors (ICI). ICI therapy represents a novel treatment modality for advanced-stage malignancies, including melanoma, metastatic renal cell cancer, and non-small cell lung cancers. ICIs have been shown to provide significant mortality benefit and are generally well-tolerated. The major adverse effects associated with ICIs are immune-mediated toxicities, which can affect multiple different organ systems. Immune-mediated cardiotoxicity is quickly gaining recognition as a rare but devastating consequence of ICI therapy. ICI-associated cardiotoxicity can manifest in a variety of ways, including fulminant lymphocytic myocarditis, supraventricular and ventricular arrhythmias, pericardial disease, and even Takotsubo-like cardiomyopathy. While not entirely clear, the primary mechanism of injury has been hypothesized to involve hyperactivation and infiltration of cytotoxic T-cells into cardiovascular tissue. The diagnosis is typically made using cardiac biomarkers and imaging, in conjunction with endomyocardial biopsy when necessary. Treatment options remain limited and generally focus on immunosuppression.