Korean Circ J.  2020 Sep;50(9):743-753. 10.4070/kcj.2020.0158.

Cardiovascular Complications of Novel Anti-Cancer Immunotherapy: Old Problems from New Agents?

• Chung WB
• Youn JC
• Youn HJ

• KMID: 2505730
• DOI: http://doi.org/10.4070/kcj.2020.0158

Abstract

Many novel anti-cancer therapies have dramatically improved outcomes of various cancer patients. However, it also poses a risk for cardiovascular complications as well. For the novel anti-cancer agent with which physicians does not have enough clinical experiences to determine the characteristics of cardiovascular complications, it is important to assess risk factors for cardiotoxicity before starting anti-cancer therapy. High-risk patient should be consulted to cardiologist before initiating anti-cancer therapy and pre-emptive cardiac function monitoring plan might be prepared in advance. The biomarkers, electrocardiography and echocardiography are useful tools for the detection of subclinical cardiotoxicity during anti-cancer therapy. This review article tried to suggest the cardiac function monitoring strategies for newly encountered potential cardiotoxic anti-cancer agents and to summarize the cardiovascular complications of novel anti-cancer immunotherapies including immune checkpoint inhibitor (ICI) and chimeric antigen receptor (CAR) T-cell therapy. ICIs can cause fatal myocarditis, which usually occurs early after initiation, and prompt treatment with high-dose corticosteroid is necessary. CAR T-cell therapy can cause cytokine release syndrome, which may result in circulatory collapse. Supportive treatment as well as tocilizumab, an anti-interleukin-6 receptor antibody are cornerstones of treatment.

Keyword

Anti-cancer therapy; Cardiovascular toxicity; Cancer immunotherapy; Immune checkpoint inhibitor; Chimeric antigen receptor T cell therapy