TY - JOUR
T1 - Cardiotoxicity associated with immune checkpoint inhibitors and CAR T-cell therapy
AU - Lipe, Demis N.
AU - Rajha, Eva
AU - Wechsler, Adriana H.
AU - Gaeta, Susan
AU - Palaskas, Nicolas L.
AU - Alhajji, Zahra
AU - Viets-Upchurch, Jayne
AU - Chaftari, Patrick
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/12
Y1 - 2021/12
N2 - Introduction: The expanding use of immunotherapy and the growing population of patients with cancer has led to an increase in the reporting of immune related adverse events (irAEs). The emergency clinician should be aware of these emerging toxicities, some of which can be fatal. In this review we discuss the cardiotoxic side effects of immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T-cell (CAR T-cell) therapy. Discussion: Recognizing the possible presentations of cardiotoxic irAEs is of utmost important as the diagnosis of cardiotoxicity associated with ICI and CAR T-cell can be difficult to make in the emergency department. The emergency clinician will have to presume the diagnosis and treat it without final confirmation in most cases. For this reason, if the diagnosis is suspected, early involvement of the cardiologist and oncologist is important to help guide management. Most irAEs will be treated with glucocorticoids, but in the case of CAR T-cell cardiotoxicity, Tocilizumab should be used as first line. Conclusion: Although cardiotoxicity is rare, it is often life-threatening. Treatment should be initiated as soon as the diagnosis is suspected, and early involvement of the cardiologist and oncologist is imperative for optimal treatment.
AB - Introduction: The expanding use of immunotherapy and the growing population of patients with cancer has led to an increase in the reporting of immune related adverse events (irAEs). The emergency clinician should be aware of these emerging toxicities, some of which can be fatal. In this review we discuss the cardiotoxic side effects of immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T-cell (CAR T-cell) therapy. Discussion: Recognizing the possible presentations of cardiotoxic irAEs is of utmost important as the diagnosis of cardiotoxicity associated with ICI and CAR T-cell can be difficult to make in the emergency department. The emergency clinician will have to presume the diagnosis and treat it without final confirmation in most cases. For this reason, if the diagnosis is suspected, early involvement of the cardiologist and oncologist is important to help guide management. Most irAEs will be treated with glucocorticoids, but in the case of CAR T-cell cardiotoxicity, Tocilizumab should be used as first line. Conclusion: Although cardiotoxicity is rare, it is often life-threatening. Treatment should be initiated as soon as the diagnosis is suspected, and early involvement of the cardiologist and oncologist is imperative for optimal treatment.
KW - CAR-T
KW - Cardiotoxicity
KW - Immune checkpoint inhibitors
KW - emergency department
KW - irAEs, immune related adverse events
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U2 - 10.1016/j.ajem.2021.07.014
DO - 10.1016/j.ajem.2021.07.014
M3 - Review article
C2 - 34274878
AN - SCOPUS:85110276798
SN - 0735-6757
VL - 50
SP - 51
EP - 58
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -