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Review
. 2025 Feb;120(1):153-169.
doi: 10.1007/s00395-024-01077-7. Epub 2024 Sep 3.

Immuno-related cardio-vascular adverse events associated with immuno-oncological treatments: an under-estimated threat for cancer patients

Giuseppe Panuccio #  1   2 , Pierpaolo Correale #  3   4 , Maria d'Apolito  5   3 , Luciano Mutti  4   6 , Rocco Giannicola  3 , Luigi Pirtoli  4 , Antonio Giordano  4   7 , Demetrio Labate  8 , Sebastiano Macheda  8 , Nicole Carabetta  9 , Youssef S Abdelwahed  10   11 , Ulf Landmesser  10   11   12 , Pierfrancesco Tassone  5   4 , Pierosandro Tagliaferri  5 , Salvatore De Rosa  9 , Daniele Torella  13
Affiliations
Review

Immuno-related cardio-vascular adverse events associated with immuno-oncological treatments: an under-estimated threat for cancer patients

Giuseppe Panuccio et al. Basic Res Cardiol. 2025 Feb.

Abstract

Immunotherapy represents an emergent and heterogeneous group of anticancer treatments harnessing the human immune-surveillance system, including immune-checkpoint inhibitor monoclonal antibodies (mAbs), Chimeric Antigen Receptor T Cells (CAR-T) therapy, cancer vaccines and lymphocyte activation gene-3 (LAG-3) therapy. While remarkably effective against several malignancies, these therapies, often in combination with other cancer treatments, have showed unforeseen toxicity, including cardiovascular complications. The occurrence of immuno-mediated adverse (irAEs) events has been progressively reported in the last 10 years. These irAEs present an extended range of severity, from self-limiting to life-threatening conditions. Although recent guidelines in CardioOncology have provided important evidence in managing cancer treatments, they often encompass general approaches. However, a specific focus is required due to the particular etiology, unique risk factors, and associated side effects of immunotherapy. This review aims to deepen the understanding of the prevalence and nature of cardiovascular issues in patients undergoing immunotherapy, offering insights into strategies for risk stratification and management.

Keywords: Cancer therapy; CardioOncology; Cardioprotection; Cardiovascular prevention; Heart failure; Immunotherapy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Immunotherapy drugs mechanisms; A CTLA-4 mAbs; B PD-1/PD-L1 mAbs
Fig. 2
Fig. 2
Lymphocyte activation gene-3 (LAG-3) therapy
Fig. 3
Fig. 3
Cancer vaccines injection and pathways generating immune response against cancer cells
Fig. 4
Fig. 4
Chimeric antigen receptor (CAR) T cell therapy mechanisms
See this image and copyright information in PMC

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