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Cardiovascular Complications Associated With Novel Cancer Immunotherapies

  • Varun Jain
  • Jaspreet Bahia
  • Mahsa Mohebtash
  • Ana Barac
Cardio-oncology (M Fradley, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardio-oncology

Opinion statement

Immune therapies represent a quantum leap in the fight against cancer. Recently approved immune checkpoint inhibitors that target receptors involved in immune escape of cancer cells (including cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein-1 (PD-1), and programmed cell death protein ligand-1 (PD-L1) are increasingly being used for therapeutic benefit in a number of cancers. The robust anti-cancer activity of these agents has been accompanied by the recognition of new adverse effects, often due to the over activation of immune system, that may limit their therapeutic benefit and adversely impact outcomes. Combination treatments in particular, such as approaches using two targeted immunotherapy agents, have higher risk of adverse effects. Our review focuses on the approved checkpoint inhibitor therapies and their potential for cardiovascular toxicity. While very few cases of autoimmune cardiotoxicity and myocarditis have been reported in clinical trials, severe, life-threatening episodes of heart failure and hemodynamic compromise associated with the use of immune checkpoint inhibitors have recently been reported in the literature. Early recognition, diagnosis, and management of autoimmune myocarditis represent an important clinical challenge with no current guidelines available for prevention, identification, and treatment of this serious condition. This area of cardio-oncology is evolving rapidly as more drugs in this class are being discovered and pending approval. There is a need for future studies focused on prospective identification of biomarkers and clinical standards for treatment and long-term follow-up of cardiovascular toxicity to successfully continue the treatment of cancer while preventing the adverse outcomes with novel immune therapies.

Keywords

Checkpoint inhibitor Cytotoxic T cell-associated antigen-4 Programmed cell death protein-1 Programmed cell death protein ligand-1 Autoimmune myocarditis Acute heart failure 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as:• Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Varun Jain
    • 1
    • 2
  • Jaspreet Bahia
    • 2
  • Mahsa Mohebtash
    • 3
  • Ana Barac
    • 1
    • 2
    • 4
  1. 1.MedStar Washington Hospital CenterWashington, DCUSA
  2. 2.Georgetown UniversityWashington, DCUSA
  3. 3.MedStar Union Memorial HospitalBaltimoreUSA
  4. 4.MedStar Heart and Vascular InstituteWashington, DCUSA

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