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Cited by 51Cancer Immunotherapy and BiomarkersChemotherapy-induced cardiotoxicity and mitigationCardiac tumors and thrombi

Risk Factors for Immune Checkpoint Inhibitor–Mediated Cardiovascular Toxicities

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Yousif, Laura I., Screever, Elles M., Versluis, Daniëlle, Aboumsallem, Joseph Pierre, Nierkens, Stefan, Manintveld, Olivier C., de Boer, Rudolf A., Meijers, Wouter C.·2023·Current Oncology Reports
DOI 10.1007/s11912-023-01414-4PMC PMC10256640
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Abstract

Purpose of Review: Immune checkpoint inhibitors (ICIs) have improved the field of cancer, especially in patients with advanced malignancies. Nevertheless, cardiovascular immune-related adverse events (irAEs) with high mortality and morbidity have been observed, including myocarditis, pericarditis, and vasculitis. To date, only a few clinical risk factors have been described and are currently being investigated. Recent Findings: In this review, we address the four most prevailing risk factors for cardiovascular irAEs. ICI combination therapy is a predominant risk factor for developing ICI-mediated myocarditis. Additionally, ICI combined with other anti-cancer treatments (e.g., tyrosine kinase inhibitors, radiation, chemotherapy) seems to increase the risk of developing cardiovascular irAEs. Other risk factors include female sex, pre-existing cardiovascular disease, and specific tumors, on which we will further elaborate in this review. Summary: An a priori risk strategy to determine who is at risk to develop these cardiovascular irAEs is needed. Insights into the impact of risk factors are therefore warranted to help clinicians improve care and disease management in these patients.

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  • Combination therapy with anti-PD-1 and anti-CTLA-4 antibodies is a main risk factor predisposing to ICI myocarditis.

    “Combination therapy (eg, anti-PD-1 and anti-CTLA-4 antibodies) and baseline thymus abnormalities, including the primary tumor being thymoma, have been the only main risk factors identified so far predisposing to ICI myocarditis.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [182]

  • Baseline thymus abnormalities, including the primary tumor being thymoma, are a main risk factor predisposing to ICI myocarditis.

    “Combination therapy (eg, anti-PD-1 and anti-CTLA-4 antibodies) and baseline thymus abnormalities, including the primary tumor being thymoma, have been the only main risk factors identified so far predisposing to ICI myocarditis.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [182]

    The Tumor Type and Clinical Perspective sections discuss tumor type and other risk factors, but no passage in our copy identifies baseline thymus abnormalities or thymoma as a risk factor for ICI myocarditis. Searches for thymoma, thymus abnormalities, and thymic tumors found no passage addressing that specific claim; the Clinical Perspective instead names combination treatment as the predominant risk factor. (LLM, conf=0.72)

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Cited by

Sorted by citations

Authors
Yousif, L. I., Screever, E. M., Versluis, D., Aboumsallem, J. P., Nierkens, S., Manintveld, O. C., de Boer, R. A., & Meijers, W. C.
Affiliations
  • Erasmus MC (NL)
  • Utrecht University (NL)
Corresponding author
Meijers, Wouter C.
ORCID
Venue
Current Oncology Reports
Publisher
Springer Science and Business Media LLC
Published
2023-04-20
Volume
25
Issue
7
Pages
753-763
ISSN
  • 1523-3790 (ISSN-L)
  • 1534-6269
DOI
10.1007/s11912-023-01414-4
PMC
PMC10256640
OpenAlex
W4366464007
Cited by
51
References
6
Citations by year
2026: 20 · 2025: 16 · 2024: 12 · 2023: 3
FWCI
1.65
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Oncology Reports (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Funders
  • Hartstichting (Dekkerbeurs 03-005-2021-T005)
  • Junior Scientific Masterclass (MA 20-04)
  • European Research Council (ERC CoG 818715, SECRETE-HF)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Chemotherapy-induced cardiotoxicity and mitigation
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
Keywords
immune checkpoint inhibitors, immune-related adverse events, cardiotoxicity, myocarditis, pericarditis, vasculitis, risk factors, combination therapy, tyrosine kinase inhibitors, female sex, pre-existing cardiovascular disease, cancer types, risk stratification
MeSH terms
Antineoplastic Agents, Immunological, Immune Checkpoint Inhibitors, Cardiovascular System, Female, Humans, Myocarditis, Neoplasms, Risk Factors

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