PD-1/PDL-1 Inhibitors and Cardiotoxicity; Molecular, Etiological and Management Outlines

Abstract

Background: The US Food and Drug Administration (FDA) has approved several immunotherapeutic drugs for cancer since 2010, and many more are still being evaluated in other clinical studies. These inhibitors significantly increase response rates and result in the treatment of patients with advanced cancer. However, cancer immunotherapy leads to essential cardiac toxicity properties that have become distinct from other cancer patients' care and are mostly related to their etiology.

Aim of review: As potential implications, the occurrence of cardiovascular adverse events is particularly challenging and needs a comprehensive understanding of overall cancer-related etiology, clinical outcomes with different variable severity, and management.

Key scientific concepts of review: In terms of improving the overall survival of patients with cancer, clinicians should be careful in selecting either programmed cell death-1 (PD-1) or its programmed cell death ligand (PDL-1) inhibitors by evaluating their risk and clinical benefit for early intervention and decrease the level of morbidity and mortality of their patients. This review focuses on the effectiveness of PD-1/PL-1 antibodies and associated cardiotoxicity adverse events, including etiological mechanisms, diagnosis, and treatment.

Keywords: Cardiotoxicity; Heart block; Myocarditis; PD-1; PDL-1.

Graphical abstract

Fig. 1

Intrinsic and extrinsic etiological factors for cardiotoxicity-related PD-1/PDL-1 inhibitors.

Fig. 2

Diagnostic and treatment outlines for PD-1/PDL-1 drugs-related cardiotoxicity complications. FDG/PET: fluorodeoxyglucose/positron emission tomography, EMB: endomyocardial biopsy, BNP: brain natriuretic peptide, NT-proBNP: N-terminal pro-brain natriuretic peptide - N/R: no response. G/P: good performance. P/P: poor performance.