Risk Factors for Immune Checkpoint Inhibitor-Mediated Cardiovascular Toxicities

Purpose of ReviewImmune checkpoint inhibitors (ICIs) have improved the field of cancer, especially in patients with advanced malignancies. Nevertheless, cardiovascular immune-related adverse events (irAEs) with high mortality and morbidity have been observed, including myocarditis, pericarditis, and vasculitis. To date, only a few clinical risk factors have been described and are currently being investigated.Recent FindingsIn this review, we address the four most prevailing risk factors for cardiovascular irAEs. ICI combination therapy is a predominant risk factor for developing ICI-mediated myocarditis. Additionally, ICI combined with other anti-cancer treatments (e.g., tyrosine kinase inhibitors, radiation, chemotherapy) seems to increase the risk of developing cardiovascular irAEs. Other risk factors include female sex, pre-existing cardiovascular disease, and specific tumors, on which we will further elaborate in this review.An a priori risk strategy to determine who is at risk to develop these cardiovascular irAEs is needed. Insights into the impact of risk factors are therefore warranted to help clinicians improve care and disease management in these patients.

Automated summary

This review discusses the four main risk factors for immune checkpoint inhibitor-related cardiovascular adverse events (irAEs), including ICI combination therapy, combination with other anti-cancer treatments, female sex, pre-existing cardiovascular disease, and specific tumors. An a priori risk strategy is needed to determine who is at risk for developing these cardiovascular irAEs, and a better understanding of the impact of risk factors is crucial for improving care and disease management in these patients.