Immune Checkpoint Inhibitor Therapy in Oncology: Current Uses and Future Directions: JACC: CardioOncology State-of-the-Art Review

Sean Tan; Daphne Day; Stephen J Nicholls; Eva Segelov

doi:10.1016/j.jaccao.2022.09.004

Immune Checkpoint Inhibitor Therapy in Oncology: Current Uses and Future Directions: JACC: CardioOncology State-of-the-Art Review

JACC CardioOncol. 2022 Dec 20;4(5):579-597. doi: 10.1016/j.jaccao.2022.09.004. eCollection 2022 Dec.

Authors

Sean Tan^{1

2}, Daphne Day^{3

4}, Stephen J Nicholls^{1

2}, Eva Segelov^{3

4}

Affiliations

¹ Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia.
² Monash Heart, Monash Health, Clayton, Victoria, Australia.
³ School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Oncology, Monash Health, Clayton, Victoria, Australia.

Abstract

Immune checkpoint inhibitors (ICIs) are a major class of immuno-oncology therapeutics that have significantly improved the prognosis of various cancers, both in (neo)adjuvant and metastatic settings. Unlike other conventional therapies, ICIs elicit antitumor effects by enhancing host immune systems to eliminate cancer cells. There are 3 approved ICI classes by the U.S. Food and Drug Administration: inhibitors targeting cytotoxic T lymphocyte associated antigen 4, programmed death 1/programmed death-ligand 1, and lymphocyte-activation gene 3, with many more in development. ICIs are commonly associated with distinct toxicities, known as immune-related adverse events, which can arise during treatment or less frequently be of late onset, usually relating to excessive activation of the immune system. Acute cardiovascular immune-related adverse events such as myocarditis are rare; however, data suggesting chronic cardiovascular sequelae are emerging. This review presents the current landscape of ICIs in oncology, with a focus on important aspects relevant to cardiology.

Keywords: CTLA-4, cytotoxic T lymphocyte associated antigen 4; ICI, immune checkpoint inhibitors; LAG-3, lymphocyte-activation gene 3; MSI, microsatellite instability; PD-L1, programmed death-ligand 1; TMB, tumor mutational burden; TME, tumor microenvironment; biomarkers; cardio-oncology; cardiotoxicity; immune checkpoint inhibitors; immune related adverse events; immunotherapy; irAE, immune-related adverse event; medical oncology.

Publication types

Review