Cancer remains a prominent global cause of mortality, second only to cardiovascular disease. The past decades have witnessed substantial advancements in anti-cancer therapies, resulting in improved outcomes. Among these advancements, immunotherapy has emerged as a promising breakthrough, leveraging the immune system to target and eliminate cancer cells. Despite the remarkable potential of immunotherapy, concerns have arisen regarding associations with adverse cardiovascular events. This review examines the complex interplay between immunotherapy and cardiovascular toxicity and provides an overview of immunotherapy mechanisms, clinical perspectives, and potential biomarkers for adverse events, while delving into the intricate immune responses and evasion mechanisms displayed by cancer cells. The focus extends to the role of immune checkpoint inhibitors in cancer therapy, including CTLA-4, PD-1, and PD-L1 targeting antibodies. This review underscores the multifaceted challenges of managing immunotherapy-related cardiovascular toxicity. Risk factors for immune-related adverse events and major adverse cardiac events are explored, encompassing pharmacological, treatment-related, autoimmune, cardiovascular, tumor-related, social, genetic, and immune-related factors. The review also advocates for enhanced medical education and risk assessment tools to identify high-risk patients for preventive measures. Baseline cardiovascular evaluations, potential prophylactic strategies, and monitoring of emerging toxicity symptoms are discussed, along with the potential of adjunct anti-inflammatory therapies.
癌症仍是全球主要死亡原因，仅次于心血管疾病。过去数十年间，抗癌疗法取得显著进展，患者预后得到改善。其中，免疫疗法通过调动免疫系统靶向清除癌细胞，已成为前景广阔的重大突破。尽管免疫疗法潜力巨大，但其与不良心血管事件的关联性引发关注。本综述探讨免疫疗法与心血管毒性之间的复杂相互作用，概述免疫疗法的作用机制、临床视角及不良事件的潜在生物标志物，同时深入分析癌细胞表现出的复杂免疫应答与逃逸机制。重点延伸至免疫检查点抑制剂在癌症治疗中的作用，包括CTLA-4、PD-1和PD-L1靶向抗体。本文强调免疫疗法相关心血管毒性管理的多维挑战，系统探讨免疫相关不良事件和主要不良心脏事件的风险因素，涵盖药理学、治疗相关、自身免疫、心血管、肿瘤相关、社会、遗传及免疫相关等多重因素。同时倡导加强医学教育和风险评估工具开发，以识别高危患者并实施预防措施。文中讨论了基线心血管评估、潜在预防策略、新发毒性症状监测，以及辅助抗炎治疗的潜在价值。
肿瘤(癌症)患者之家