Montisci Andrea, Vietri Maria Teresa, Palmieri Vittorio, Sala Silvia, Donatelli Francesco, Napoli Claudio
Division of Cardiothoracic Intensive Care, ASST Spedali Civili, 25123 Brescia, Italy.
Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 81100 Naples, Italy.
Cancers (Basel). 2021 Sep 25;13(19):4797. doi: 10.3390/cancers13194797.
Cancer immunotherapy significantly contributed to an improvement in the prognosis of cancer patients. Immunotherapy, including human epidermal growth factor receptor 2 (HER2)-targeted therapies, immune checkpoint inhibitors (ICI), and chimeric antigen receptor-modified T (CAR-T), share the characteristic to exploit the capabilities of the immune system to kill cancerous cells. Trastuzumab is a monoclonal antibody against HER2 that prevents HER2-mediated signaling; it is administered mainly in HER2-positive cancers, such as breast, colorectal, biliary tract, and non-small-cell lung cancers. Immune checkpoint inhibitors (ICI) inhibit the binding of CTLA-4 or PD-1 to PDL-1, allowing T cells to kill cancerous cells. ICI can be used in melanomas, non-small-cell lung cancer, urothelial, and head and neck cancer. There are two main types of T-cell transfer therapy: tumor-infiltrating lymphocytes (or TIL) therapy and chimeric antigen receptor-modified T (CAR-T) cell therapy, mainly applied for B-cell lymphoma and leukemia and mantle-cell lymphoma. HER2-targeted therapies, mainly trastuzumab, are associated with left ventricular dysfunction, usually reversible and rarely life-threatening. PD/PDL-1 inhibitors can cause myocarditis, rare but potentially fulminant and associated with a high fatality rate. CAR-T therapy is associated with several cardiac toxic effects, mainly in the context of a systemic adverse effect, the cytokines release syndrome.
癌症免疫疗法显著改善了癌症患者的预后。免疫疗法，包括针对人表皮生长因子受体2（HER2）的疗法、免疫检查点抑制剂（ICI）和嵌合抗原受体修饰的T细胞（CAR-T），都具有利用免疫系统能力来杀死癌细胞的特点。曲妥珠单抗是一种抗HER2的单克隆抗体，可阻止HER2介导的信号传导；它主要用于HER2阳性癌症，如乳腺癌、结直肠癌、胆管癌和非小细胞肺癌。免疫检查点抑制剂（ICI）可抑制CTLA-4或PD-1与PDL-1的结合，使T细胞能够杀死癌细胞。ICI可用于黑色素瘤、非小细胞肺癌、尿路上皮癌以及头颈癌。T细胞转移疗法主要有两种类型：肿瘤浸润淋巴细胞（或TIL）疗法和嵌合抗原受体修饰的T（CAR-T）细胞疗法，主要应用于B细胞淋巴瘤、白血病和套细胞淋巴瘤。针对HER2的疗法，主要是曲妥珠单抗，与左心室功能障碍有关，通常是可逆的，很少危及生命。PD/PDL-1抑制剂可导致心肌炎，虽然罕见但可能呈暴发性，且死亡率很高。CAR-T疗法与多种心脏毒性作用有关，主要在全身性不良反应即细胞因子释放综合征的情况下出现。
