Management of Patients with Cardiac Toxicity: The Point of View of the Oncologist

The discovery of immune checkpoint inhibitors (ICIs) as antineoplastic therapies revolutionized the field of oncology, improving the prognosis of different cancers at the cost of possible adverse events, mostly based on immune activation against normal tissues. Most common immune-related adverse events (irAEs) are cutaneous, endocrinological, pulmonary, and gastrointestinal. Cardiovascular irAEs are much less frequently reported but burdened by higher mortality rates. ICI-related cardiotoxicity includes myocarditis, pericardial diseases and, to a lesser extent, the Takotsubo syndrome, arrhythmias, acute coronary syndromes, and vasculitis. The first action recommended for the majority of suspected cardiovascular irAE is the prompt discontinuation of the ICIs and timely administration of high doses of corticosteroids, even if immunosuppressive therapy doesn’t always succeed to reverse cardiological toxicities. Different types of cardiotoxicity can also occur with cell-based immune-therapy treatments (e.g., CAR-T), requiring specific diagnosis and management protocols. Because of the high morbidity and mortality, an early diagnosis of cardiological irAEs is essential for framing the optimal management within an expert multidisciplinary approach for the therapeutic decision-making.