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Immune checkpoint inhibitors: acute and chronic cardiovascular complications

Nature Reviews Cardiology volume 20, pages 73–74 (2023)Cite this article

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Immune checkpoint inhibitors (ICIs) have become a pillar of cancer therapy. The cardiovascular complications of ICIs extend beyond myocarditis and can involve any component of the cardiovascular system, including the pericardium, coronary arteries and conduction system. Clinicians caring for patients treated with ICIs must be vigilant for the cardiovascular complications of these therapies, which might portend a poor prognosis.

At present, there are >100 FDA approvals for immune checkpoint inhibitors (ICIs) and 36% of patients with cancer in the USA are eligible for this lifesaving therapy1. With >5,000 clinical trials involving ICI therapy underway, the number of eligible patients will grow. Immune checkpoints are receptors that, when activated, typically block the immune response and function as an important safeguard to prevent autoimmunity. These receptors are also expressed by tumour cells, providing a mask that allows them to evade immune detection. Monoclonal antibodies targeting immune checkpoints can reverse immune escape and promote tumour cell death. Approved ICIs target immune checkpoints on T cells, such as cytotoxic T lymphocyte antigen 4 (CTLA4), lymphocyte activation gene 3 protein (LAG3), and programmed cell death protein 1 (PD1) and its ligand, programmed cell death 1 ligand 1 (PD-L1). Several other pathways are under investigation, including T cell immunoreceptor with immunoglobulin and ITIM domains (TIGIT), T cell immunoglobulin mucin receptor 3 (TIM3) and leukocyte surface antigen CD47.

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Fig. 1: Pathophysiology of ICI-mediated atherosclerosis.

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Authors and Affiliations

  1. Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Kiranbir Josan

  2. Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA

    Tomas G. Neilan

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  1. Kiranbir Josan
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  2. Tomas G. Neilan
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Correspondence to Kiranbir Josan.

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Competing interests

T.G.N. has received consulting fees from AbbVie, Amgen, Bristol Myers Squibb, CRO Oncology, Genentech, H3 Biomedicine, Roche and Sanofi, and has received grant funding from AstraZeneca and Bristol Myers Squibb for work related to the cardiovascular complications of immune checkpoint inhibitors. K.J. declares no competing interests.

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Josan, K., Neilan, T.G. Immune checkpoint inhibitors: acute and chronic cardiovascular complications. Nat Rev Cardiol 20, 73–74 (2023). https://doi.org/10.1038/s41569-022-00827-1

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