Mocan-Hognogi Diana Larisa, Trancǎ Sebastian, Farcaş Anca Daniela, Mocan-Hognogi Radu Florin, Pârvu Andrada Viorica, Bojan Anca Simona
Internal Medicine Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
1st Cardiology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
Front Cardiovasc Med. 2021 Sep 29;8:726426. doi: 10.3389/fcvm.2021.726426. eCollection 2021.
Immune checkpoint inhibitors (ICIs) represent a break-through treatment for a large number of cancer types. This treatment is increasingly being recommended. ICIs are prescribed for primary tumours and for metastases, adjuvant/neo-adjuvant therapy. Thus, there is an increased need for expertise in the field, including the ways of response and toxicities related to them. ICIs become toxic because of the removal of self-tolerance, which in turn induces autoimmune processes that affect every organ. However, when relating to the heart, it has been noticed to be leading to acute heart failure and even death caused by various mechanisms, such as: myocarditis, pericarditis, arrhythmia, and Takotsubo cardiomyopathy. This review aims to address the above issues by focusing on the latest findings on the topic, by adding some insights on the mechanism of action of ICIs with a special focus on the myocardial tissue, by providing information on clinical manifestations, diagnosis and (wherever possible) treatment of the cardiotoxic events related to this therapy. The information is expanding and in many cases, the articles we found refer mainly to case-presentations and studies conducted on small populations. However, we consider that it is worthwhile to raise awareness of this new treatment, especially since it is widely now and it provides a significant increase in the survival rate in patients who receive it.
免疫检查点抑制剂（ICIs）是多种癌症类型的突破性治疗方法。这种治疗方法越来越受到推荐。ICIs被用于原发性肿瘤、转移瘤以及辅助/新辅助治疗。因此，该领域对专业知识的需求日益增加，包括与它们相关的反应方式和毒性。ICIs会因为自身耐受性的消除而产生毒性，这反过来又会引发影响各个器官的自身免疫过程。然而，就心脏而言，人们已经注意到它会导致急性心力衰竭，甚至因各种机制导致死亡，如：心肌炎、心包炎、心律失常和应激性心肌病。本综述旨在通过关注该主题的最新研究结果，对ICIs的作用机制（特别关注心肌组织）增加一些见解，提供与该治疗相关的心脏毒性事件的临床表现、诊断和（尽可能）治疗方面的信息，来解决上述问题。相关信息正在不断扩展，在很多情况下，我们找到的文章主要涉及病例报告和对小群体进行的研究。然而，我们认为提高对这种新治疗方法的认识是值得的，特别是因为它现在已广泛应用，并且能显著提高接受治疗患者的生存率。
