The emergence of immunotherapies in the field of oncology has improved outcomes and
given hope to patients with cancer diagnoses that have traditionally carried a poor prognosis.
Specifically, Immune Checkpoint Inhibitors (ICIs), target Cytotoxic T Lymphocyte-Associated
Antigen 4 (CTLA-4) and Programmed Cell Death 1 (PD-1), all of which have key roles in regulating
the immune response. Manipulation of these immune checkpoint pathways allows the body to exert a
greater antitumor response but this unrestricted immune response comes with an array of Autoimmune
Related Adverse Events (IRAEs). The most commonly reported IRAEs are generally nonlife
threatening and include fatigue, pruritus, diarrhea, and rash. In the literature, there have been a
growing number of case reports detailing cardiotoxicity in patients receiving ICIs. Unlike the more
common IRAEs, ICI induced cardiotoxicity is associated with greater mortality. This article aims to
describe the plausible mechanisms of ICI related cardiotoxicity as well as strategies for clinicians to
recognize and manage cardiotoxicity. As immunotherapy based treatment strategies continue to
widen and the population of patients receiving these agents expands, increasing provider awareness of
potentially fatal toxicities will continue to be an important issue.
Keywords: Immunotherapy, cancer, myocarditis, ipilimumab, nivolumumab, pembrolizumab.
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