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Cardiotoxicity associated with CTLA4 and PD1 blocking immunotherapy
Open accessAbstract
Immune-checkpoint blocking antibodies have demonstrated objective antitumor responses in multiple tumor types including melanoma, non-small cell lung cancer (NSCLC), and renal cell cancer (RCC). In melanoma, an increase in overall survival has been demonstrated with anti-CTLA-4 and PD-1 inhibition. However, a plethora of immune-mediated adverse events has been reported with these agents. Immune-mediated cardiotoxicity induced by checkpoint inhibitors has been reported in single cases with variable presentation, including myocarditis and pericarditis. Among six clinical cancer centers with substantial experience in the administration of immune-checkpoint blocking antibodies, eight cases of immune-related cardiotoxicity after ipilimumab and/or nivolumab/pembrolizumab were identified. Diagnostic findings, treatment and follow-up are reported. A large variety of cardiotoxic events with manifestations such as heart failure, cardiomyopathy, heart block, myocardial fibrosis and myocarditis was documented. This is the largest case series to date describing cardiotoxicity of immune-checkpoint blocking antibodies. Awareness, monitoring of patients with pre-existing cardiac disorders and prompt evaluation by the treatment team is essential. Treatment including application of steroids is critical for patient safety.
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“Cardiac biopsies from patients with ICI myocarditis revealed myocardial infiltration primarily by T cells”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [118]
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“one of the best examples of drug-induced lymphocytic myocarditis is ICI myocarditis, which may occur following ICI treatment in patients with cancer.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [118]
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“suggesting a potential role of T cells in driving the pathogenesis of this condition.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [118]
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Metadata
- Authors
- Heinzerling, L., Ott, P. A., Hodi, F. S., Husain, A. N., Tajmir-Riahi, A., Tawbi, H., Pauschinger, M., Gajewski, T. F., Lipson, E. J., & Luke, J. J.
- Affiliations
- Universitätsklinikum Erlangen (DE)
- Dana-Farber Cancer Institute (US)
- University of Chicago (US)
- The University of Texas MD Anderson Cancer Center (US)
- Paracelsus Medizinische Privatuniversität (DE)
- Sidney Kimmel Comprehensive Cancer Center (US)
- Corresponding author
- Heinzerling, Lucie
- ORCID
- Venue
- Journal for ImmunoTherapy of Cancer
- Publisher
- BMJ
- Published
- 2016-08-16
- Volume
- 4
- Issue
- 1
- Pages
- 50-50
- ISSN
- 2051-1426 (ISSN-L)
- PMC
- PMC4986340
- OpenAlex
- W2478478625
- Cited by
- 511
- References
- 37
- Citations by year
- 2026: 21 · 2025: 29 · 2024: 34 · 2023: 43 · 2022: 50 · 2021: 77 · 2020: 78 · 2019: 64 · 2018: 61 · 2017: 50 · 2016: 2
- FWCI
- 31.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal for ImmunoTherapy of Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- OPUS FAU (Kooperativer Bibliotheksverbund Berlin-Brandenburg (KOBV), on behalf of the Universitätsbibliothek Erlangen-Nürnberg) (submittedVersion, cc-by)
- Funders
- Melanoma Research Alliance
- Celldex Therapeutics
- National Institutes of Health
- Genentech
- National Cancer Institute (K12CA139160)
- 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-related cardiotoxicity, CTLA-4 blockade, anti-PD-1 therapy, immune checkpoint inhibitors, ipilimumab, nivolumab, pembrolizumab, myocarditis, pericarditis, heart failure, cardiomyopathy, myocardial fibrosis, atrioventricular block, corticosteroid therapy
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