Immuno-cardio-oncology: Killing two birds with one stone?

Abstract

Inflammation and a dysregulated immune system are common denominators of cancer and cardiovascular disease (CVD). Immuno-cardio-oncology addresses the interconnected immunological aspect in both cancer and CVD and the integration of immunotherapies and anti-inflammatory therapies in both distinct disease entities. Building on prominent examples of convergent inflammation (IL-1ß biology) and immune disbalance (CD20 cells) in cancer and CVD/heart failure, the review tackles both the roadblocks and opportunities of repurposed use of IL-1ß drugs and anti-CD20 antibodies in both fields, and discusses the use of advanced therapies e.g. chimeric antigen receptor (CAR) T cells, that can address the raising burden of both cancer and CVD. Finally, it is discussed how inspired by precision medicine in oncology, the use of biomarker-driven patient stratification is needed to better guide anti-inflammatory/immunomodulatory therapeutic interventions in cardiology.

Keywords: immune cell dysbalance; immuno-cardio-oncology; inflammation; interdisciplinarity; patient stratification; repurposed therapies.

Figure 1

Immuno-cardio-oncology – anti-inflammatory and immunomodulatory strategies in CVD/heart failure and cancer. Inflammation and a dysbalanced immune system, provoked by risk factors such as smoking, age, diabetes mellitus and obesity, are common triggers in the pathogenesis of cancer and CVD/heart failure. Anti-cancer therapies comprise strategies directed to activate the immune response e.g. checkpoint inhibitors, to deplete tumor cells (anti-CD20, CAR T cells, CD3 engager), and cytostatic drugs e.g. doxorubicin, of which checkpoint inhibitors, CAR T cells and doxorubicin provoke cardiac inflammation. In contrast, immunosuppressive therapies like corticosteroids and B7-antagonists are used for the treatment of CVD and heart failure. Repurposed (immune) cell depletion strategies (anti-CD20, CD19 antibodies, CAR T cells, CD3 engager) have entered the cardiology field. Anti-inflammatory therapies (e.g. anti-IL-1ß drugs) are under investigation for the treatment of cancer, cancer therapy-related inflammation and CVD/heart failure.