Tajiri Kazuko, Ieda Masaki
Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Front Cardiovasc Med. 2019 Jan 23;6:3. doi: 10.3389/fcvm.2019.00003. eCollection 2019.
Immune checkpoint inhibitors (ICIs) have changed the treatment landscape of advanced cancers. Unfortunately, these agents can induce a wide spectrum of immune-related adverse events (irAEs) through activation of immune responses in non-target organs, including the heart. As the clinical use of ICI therapy increases rapidly, management of irAEs is becoming extremely important. The most commonly presented cardiac irAE is myocarditis. Histopathologically, T-cell (with a predominance of CD8 cells) and macrophage infiltration in the myocardium is typically observed in ICI-associated myocarditis. Other presentations of cardiac irAEs include congestive heart failure, Takotsubo cardiomyopathy, pericardial disease, arrhythmias, and conduction disease. Although cardiac irAEs are relatively rare, they can be life-threatening. Hence, cardiologists and oncologists should be vigilant for these presentations.
免疫检查点抑制剂(ICIs)已经改变了晚期癌症的治疗格局。不幸的是,这些药物可通过激活非靶器官(包括心脏)中的免疫反应,诱发广泛的免疫相关不良事件(irAEs)。随着ICI疗法的临床应用迅速增加,irAEs的管理变得极为重要。最常见的心脏irAE是心肌炎。在组织病理学上,ICI相关心肌炎通常表现为心肌中T细胞(以CD8细胞为主)和巨噬细胞浸润。心脏irAEs的其他表现包括充血性心力衰竭、应激性心肌病、心包疾病、心律失常和传导疾病。虽然心脏irAEs相对罕见,但可能危及生命。因此,心脏病学家和肿瘤学家应对这些表现保持警惕。