Cardiac Complications of Immune Checkpoint Inhibitors and Chimeric Antigen Receptor T Cell Therapy

Cardiol Clin. 2025 Feb;43(1):151-167. doi: 10.1016/j.ccl.2024.07.001. Epub 2024 Aug 30.

Abstract

Immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy have revolutionized cancer treatment but can cause life-threatening cardiovascular toxicities through immune-related adverse events. Myocarditis is the most common and potentially fatal toxicity with immune checkpoint inhibitors. T-cell therapies can potentially lead to cytokine release syndrome. Diagnosis of ICI-myocarditis requires a multimodal approach, including biomarkers, imaging, and endomyocardial biopsy, while CRS is characterized by a clinical syndrome resembling distributive shock. Management involves discontinuing the offending therapy, immunosuppression with corticosteroids for ICI-myocarditis, and interleukin-6 antagonists for CRS. Collaboration between oncologists and cardiologists is crucial for early recognition and prompt treatment.

Keywords: CAR T-cell therapy; Cardiotoxicity; Cytokine release syndrome (CRS); Immune checkpoint inhibitors; Myocarditis; Pericarditis.

Publication types

  • Review

MeSH terms

  • Cardiotoxicity / etiology
  • Cytokine Release Syndrome / etiology
  • Humans
  • Immune Checkpoint Inhibitors* / adverse effects
  • Immune Checkpoint Inhibitors* / therapeutic use
  • Immunotherapy, Adoptive / adverse effects
  • Immunotherapy, Adoptive / methods
  • Myocarditis / chemically induced
  • Myocarditis / diagnosis
  • Myocarditis / therapy
  • Neoplasms* / drug therapy
  • Neoplasms* / therapy
  • Receptors, Chimeric Antigen* / therapeutic use

Substances

  • Immune Checkpoint Inhibitors
  • Receptors, Chimeric Antigen