Immune checkpoint inhibitor-associated cardiotoxicity: incidence, diagnosis, and management.
7 affiliations
- 1Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. [email protected].
- 2Cairo University School of Medicine, Cairo, Egypt.
- 3School of Medicine, Anáhuac Querétaro University, Querétaro, Mexico.
- 4Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
- 5Department of Emergency Medicine, MD Anderson Cancer Center, Houston, TX, USA.
- 6School of Medicine, Autonomous University of Querétaro, Querétaro, Mexico.
- 7Department of Emergency Medicine, MD Anderson Cancer Center, Houston, TX, USA. [email protected].
Abstract
Purpose
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but are associated with immune-related adverse events (irAEs), including cardiotoxicity. This review provides a comprehensive overview of the incidence, mechanisms, diagnosis, and management of ICI-associated cardiotoxicity, highlighting emerging biomarkers, diagnostic algorithms, and risk stratification strategies.Methods
We conducted a narrative review of the literature, synthesizing findings from recent clinical studies, guidelines, and case reports concerning ICI-associated cardiovascular complications such as myocarditis, pericarditis, and arrhythmias. As a narrative rather than systematic review, studies were selected to illustrate current concepts and were not appraised against predefined eligibility criteria.Key findings
ICIs are associated with a low overall incidence of cardiovascular toxicities; however, myocarditis remains the most severe and potentially life-threatening manifestation. Reported case-fatality estimates vary widely, and the highest figures derive largely from early case series and pharmacovigilance data. Emerging biomarkers, evolving risk stratification tools, and updated diagnostic and management frameworks may improve early recognition, guide timely intervention, and support multidisciplinary care for patients with suspected ICI-associated cardiotoxicity, although most supporting evidence remains retrospective.Conclusions
Early recognition and prompt management of ICI-associated cardiotoxicities are essential for improving patient outcomes. This review provides oncologists and cardiologists with updated diagnostic approaches, treatment frameworks, and practical considerations for monitoring at-risk patients, while acknowledging that current recommendations rest largely on low-certainty evidence.
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BibTeX
@article{haddad2026immune,
title = {{Immune checkpoint inhibitor-associated cardiotoxicity: incidence, diagnosis, and management.}},
author = {Sara F Haddad and Lydia Philip and Leticia Padrón and Marianne Zoghbi and Kalen Jacobson and Kathryn Burk and Patrick Chaftari and Danna Michelle Markides and Sarah Dendy and Pavitra Krishnamani and Alejandro Mendoza Hernández and María Teresa Cruz Carreras},
journal = {Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer},
year = {2026},
month = oct,
doi = {10.1007/s00520-026-11362-x},
url = {https://europepmc.org/article/MED/42925345},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Immune checkpoint inhibitor-associated cardiotoxicity: incidence, diagnosis, and management.
AU - Sara F Haddad
AU - Lydia Philip
AU - Leticia Padrón
AU - Marianne Zoghbi
AU - Kalen Jacobson
AU - Kathryn Burk
AU - Patrick Chaftari
AU - Danna Michelle Markides
AU - Sarah Dendy
AU - Pavitra Krishnamani
AU - Alejandro Mendoza Hernández
AU - María Teresa Cruz Carreras
PY - 2026
DA - 2026/10/24
JO - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
DO - 10.1007/s00520-026-11362-x
UR - https://europepmc.org/article/MED/42925345
AB - Purpose Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but are associated with immune-related adverse events (irAEs), including cardiotoxicity. This review provides a comprehensive overview of the incidence, mechanisms, diagnosis, and management of ICI-associated cardiotoxicity, highlighting emerging biomarkers, diagnostic algorithms, and risk stratification strategies.Methods We conducted a narrative review of the literature, synthesizing findings from recent clinical studies, guidelines, and case reports concerning ICI-associated cardiovascular complications such as myocarditis, pericarditis, and arrhythmias. As a narrative rather than systematic review, studies were selected to illustrate current concepts and were not appraised against predefined eligibility criteria.Key findings ICIs are associated with a low overall incidence of cardiovascular toxicities; however, myocarditis remains the most severe and potentially life-threatening manifestation. Reported case-fatality estimates vary widely, and the highest figures derive largely from early case series and pharmacovigilance data. Emerging biomarkers, evolving risk stratification tools, and updated diagnostic and management frameworks may improve early recognition, guide timely intervention, and support multidisciplinary care for patients with suspected ICI-associated cardiotoxicity, although most supporting evidence remains retrospective.Conclusions Early recognition and prompt management of ICI-associated cardiotoxicities are essential for improving patient outcomes. This review provides oncologists and cardiologists with updated diagnostic approaches, treatment frameworks, and practical considerations for monitoring at-risk patients, while acknowledging that current recommendations rest largely on low-certainty evidence.
SN - 0941-4355
SN - 1433-7339
ER -