Cardiotoxicity induced by immune checkpoint inhibitor: The complete insight into mechanisms, monitoring, diagnosis, and treatment

Chemotherapy cardiotoxicity research in cancer patients: a bibliometric and visual analysis (1994-2024)

Background

Recent advancements in medical technology have significantly boosted the survival rates of cancer patients. The potential toxicities that cancer treatments may induce in other areas of the human body have garnered increasing attention. Chemotherapy, a pivotal component of anticancer therapy, heightens the risk of cardiac damage and contributes to various cardiovascular complications. To comprehensively assess the research landscape concerning chemotherapy-induced cardiotoxicity in cancer patients, this study conducted a visual analysis of pertinent articles utilizing bibliometric tools.

Method

We used CiteSpace, VOSviewer, to analyze the temporal and spatial distribution, disciplinary categories, authorship, references, subject terms, and keywords of 4460 articles retrieved from the Web of Science core collection from 1994 to January 21, 2024.

Results

Contributions to this field emanated from 100 countries/regions and 4,343 research institutions, with the United States, China, and Italy emerging as the most prolific contributors in terms of publication volume. The Journal of Clinical Oncology emerged as the primary journal in terms of publications and co-citations within this domain, with Bonnie Ky identified as the most prolific author. Common keywords included breast cancer, doxorubicin, heart failure, trial, adjuvant chemotherapy, paclitaxel, and risk. Terms such as echocardiography, nanoparticles, mechanisms, prevention, society, oxidative stress, inflammation, consensus, and global longitudinal strain delineated the current research frontier in this field. Additionally, the study provided a detailed examination of the fundamental aspects of research in this domain. Presently, key research focuses in this area include elucidating the mechanisms of chemotherapy-induced cardiotoxicity, monitoring and evaluating such cardiotoxicity, and developing strategies for its prevention and treatment.

Conclusion

This study provides a comprehensive overview of chemotherapy-induced cardiotoxicity research from 1994 to 2024. Future research should prioritize personalized risk assessment and interdisciplinary collaboration to meet the clinical needs of the cardiovascular oncology field.

Mediation of macrophage M1 polarization dynamics change by ubiquitin-autophagy-pathway regulated NLRP3 inflammasomes in PD-1 inhibitor-related myocardial inflammatory injury

OBJECTIVE AND DESIGN

Immune checkpoint inhibitors (ICIs)-induced cardiac injury is a life-threatening immune-related adverse events (irAEs). However, the current understanding of its pathogenesis and therapeutic options is relatively limited. We aimed to provide a comprehensive overview of the myocardial inflammatory injury process and underlying mechanisms associated with ICIs.

MATERIAL OR SUBJECTS

We conducted a descriptive analysis of lung cancer patients with ICIs-induced myocarditis at our institution and validated our clinical findings using single-cell sequencing (scRNA-seq) data. Furthermore, we established animal and cellular models to investigate the underlying mechanisms.

RESULTS

Our findings revealed that lung cancer patients with ICIs-induced myocarditis exhibit an early increase in peripheral blood monocytes, which migrate to the heart and differentiate into macrophages, ultimately leading to myocardial inflammation. Mechanistically, programmed death-1 (PD-1) inhibition triggers myocardial inflammation through the activation of the signal transducer and activator of transcription 1 (STAT1)/nuclear factor kappa-B (NF-κB)/oligomerization domain (NOD)-like receptor thermal protein domain-associated protein 3 (NLRP3) signaling pathway and drives the polarization of macrophages towards the M1 phenotype. However, the ubiquitin (Ub)-autophagy pathway degrades NLRP3 inflammasomes, resulting in the gradual resolution of inflammation and the transition of M1 macrophages to the M2 phenotype. Finally, mouse experiments confirmed that NLRP3 inhibition using MCC950 effectively alleviates myocardial inflammatory injury.

CONCLUSIONS

We recommend monitoring fluctuations in peripheral blood monocyte counts in lung cancer patients undergoing ICIs treatment. Additionally, MCC950 holds potential as a therapeutic agent for ICIs-induced cardiac inflammation injury.

Advances in research on molecular markers in immune checkpoint inhibitor-associated myocarditis

Immune checkpoint inhibitors (ICIs) play a crucial role in the immunotherapy of malignant tumors, preventing immune evasion by tumor cells and activating autoimmune cells to eliminate the tumor. Despite their proven effectiveness in antitumor therapy, potential immune-related adverse effects must be recognized, particularly ICI-associated myocarditis (ICIAM). ICIAM is the most lethal form of organ immunotoxicity, with a significant impact on short-term mortality. However, ICIAM is predominantly asymptomatic or mildly nonspecific. It is difficult to diagnose, especially due to the lack of unique molecular markers. This article aims to provide a comprehensive overview of the progress made in identifying molecular markers for ICIAM.

Tolerated Re-Challenge of Immunotherapy in a Patient with ICI Associated Myocarditis: A Case Report and Literature Review

Many different types of cancer can be treated with immunotherapy drugs called immune checkpoint inhibitors (ICIs). These drugs have altered the landscape of cancer treatment options since they function by triggering a stronger immune response to malignancy. As expected, ICIs' modification of immune regulatory controls leads to a wide range of organ/gland-specific immune-related side effects. These adverse effects are uncommonly deadly and typically improve by discontinuing treatment or administering corticosteroid drugs. As a result of a number of factors-including a lack of specificity in the clinical presentation, the possibility of overlap with other cardiovascular and general medical illnesses, difficulties in diagnosis, and a general lack of awareness-the true incidence of ICI-associated myocarditis is likely underestimated. Currently, protocols for the surveillance, diagnosis, or treatment of this condition are unclear. Several questions remain unanswered, such as how to best screen for this rare toxin, what tests should be run on patients who are suspected of having it, how to treat myocarditis once it has developed, and who is at most risk. In this article, we provide a case study of ICI-associated myocarditis and explain its key characteristics and treatment options.

Risk factors for cardiovascular adverse events from immune checkpoint inhibitors

Immune-related adverse events (irAEs), including skin injury, liver and kidney injury, colitis, as well as cardiovascular adverse events, are a series of complications arising during the treatment of immune checkpoint inhibitors (ICIs). Cardiovascular events are the most urgent and the most critical, as they can end life in a short period of time. With the widespread use of ICIs, the number of immune-related cardiovascular adverse events (irACEs) induced by ICIs has increased. More attention has been paid to irACEs, especially regarding cardiotoxicity, the pathogenic mechanism, diagnosis and treatment. This review aims to assess the risk factors for irACEs, to raise awareness and help with the risk assessment of irACEs at an early stage.