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免疫检查点抑制剂心脏毒性:了解基本机制和临床特征并寻找治疗方法。

Immune Checkpoint Inhibitor Cardiotoxicity: Understanding Basic Mechanisms and Clinical Characteristics and Finding a Cure.

机构信息

Department of Medicine, Stanford University, Stanford, California 94305, USA; email:

Stanford Cardiovascular Institute, Stanford University, Stanford, California 94305, USA.

出版信息

Annu Rev Pharmacol Toxicol. 2021 Jan 6;61:113-134. doi: 10.1146/annurev-pharmtox-010919-023451. Epub 2020 Aug 10.

Abstract

Immune checkpoint inhibitors (ICIs) attenuate mechanisms of self-tolerance in the immune system, enabling T cell responses to cancerous tissues and revolutionizing care for cancer patients. However, by loweringbarriers against self-reactivity, ICIs often result in varying degrees of autoimmunity. Cardiovascular complications, particularly myocarditis but also arrhythmias, pericarditis, and vasculitis, have emerged as significant complications associated with ICIs. In this review, we examine the clinical aspects and basic science principles that underlie ICI-associated myocarditis and other cardiovascular toxicities. In addition, we discuss current therapeutic approaches. We believe a better mechanistic understanding of ICI-associated toxicities can lead to improved patient outcomes by reducing treatment-related morbidity.

摘要

免疫检查点抑制剂(ICIs)减弱了免疫系统自身耐受的机制,使 T 细胞能够对癌细胞作出反应,从而彻底改变了癌症患者的治疗方法。然而,由于降低了自身反应性的障碍,ICI 通常会导致不同程度的自身免疫。心血管并发症,特别是心肌炎,但也包括心律失常、心包炎和血管炎,已成为与 ICI 相关的重要并发症。在这篇综述中,我们探讨了与 ICI 相关心肌炎和其他心血管毒性相关的临床方面和基础科学原理。此外,我们还讨论了当前的治疗方法。我们相信,通过减少与治疗相关的发病率,更好地了解 ICI 相关毒性的机制可以改善患者的预后。

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