Kadowaki Hiroshi, Akazawa Hiroshi, Ishida Junichi, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
JMA J. 2021 Apr 15;4(2):91-98. doi: 10.31662/jmaj.2021-0001. Epub 2021 Apr 2.
Onco-cardiology recently emerged as a novel discipline to provide effective cardioprotective care against cancer therapeutics-related cardiac adverse events (CAEs) and support the continuity of optimal cancer treatment. Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy and dramatically improved outcomes in patients with advanced or refractory cancers. However, ICIs intrinsically stimulate systemic immune responses and can potentially induce a spectrum of immune-related adverse events (irAEs), which can affect any organs of the body. The manifestation of cardiac irAEs includes myocarditis, arrhythmias and conduction abnormalities, and pericardial diseases. Takotsubo-like cardiomyopathy is also included as a manifestation of ICI-related CAEs, but the pathophysiological relevance is unclear. Although the incidence is rare, ICI-related CAEs are life-threatening and potentially fatal. Elucidating pathophysiology and establishing management measures of ICI-related CAEs are one of the most urgent challenges in the field of onco-cardiology.
肿瘤心脏病学最近作为一门新兴学科出现,旨在针对癌症治疗相关的心脏不良事件(CAEs)提供有效的心脏保护护理,并支持最佳癌症治疗的连续性。免疫检查点抑制剂(ICIs)彻底改变了癌症治疗方式,并显著改善了晚期或难治性癌症患者的治疗效果。然而,ICIs本质上会刺激全身免疫反应,并可能诱发一系列免疫相关不良事件(irAEs),这些不良事件可影响身体的任何器官。心脏irAEs的表现包括心肌炎、心律失常和传导异常以及心包疾病。应激性心肌病也被列为ICI相关CAEs的一种表现,但其病理生理相关性尚不清楚。尽管发病率很低,但ICI相关CAEs危及生命且可能致命。阐明ICI相关CAEs的病理生理学并建立管理措施是肿瘤心脏病学领域最紧迫的挑战之一。