CLINICAL MANAGEMENT OF CARDIOTOXICITY INDUCED BY IMMUNE CHECKPOINT INHIBITORS IN CANCER PATIENTS

Abstract

Cardiotoxicity induced by immune checkpoint inhibitors (ICI) represents an emerging challenge in the management of cancer patients. These agents, which include CTLA-4, PD-1 and PD-L1 inhibitors, have revolutionized oncological treatment by enhancing the immune response against tumor cells. However, these treatments can trigger serious adverse cardiovascular effects, such as myocarditis, heart failure and arrhythmias. Early recognition and effective management of these adverse events are crucial to maximize therapeutic benefits and minimize risks to patients. Objective: This systematic literature review was to evaluate clinical management strategies for ICI-induced cardiotoxicity in cancer patients, exploring preventive interventions, early diagnosis and therapeutic approaches. Methodology: based on the PRISMA checklist, with searches carried out in the PubMed, Scielo and Web of Science databases, using the descriptors "cardiotoxicity", "immune checkpoint inhibitors", "cancer", "myocarditis" and "treatment ". Studies published in the last 10 years, written in English, Portuguese or Spanish, and that specifically addressed cardiotoxicity induced by ICIs were included. Inclusion criteria included studies with detailed clinical data, management analyzes and patient monitoring. Exclusion criteria involved reviews without original clinical data, opinion articles and studies focused on forms of toxicity other than cardiac toxicity. Results: indicated that myocarditis was the most frequently reported manifestation, often associated with an abrupt and potentially lethal onset. Continuous cardiovascular monitoring, including biomarkers and cardiac imaging, has proven essential for early diagnosis. Therapeutic approaches included stopping ICIs and using immunosuppressants, such as corticosteroids, to control adverse reactions. Conclusion: ICIs-induced cardiotoxicity is a significant complication in cancer treatment, requiring monitoring and early intervention strategies to improve clinical outcomes. Multidisciplinary collaboration is vital for effective management and to ensure the safety and effectiveness of cancer treatment.