Cardio-onco collab may enhance safety of nivolumab anticancer therapy

The safety of nivolumab anticancer therapy may be improved through close collaboration between cardiology and oncology specialists, which can help detect cardiac complications early and manage these conditions effectively, suggests a study.

A team of investigators searched the online databases of PubMed, Scopus, Google Scholar, and Embase for studies on nivolumab.

The use of immune checkpoint inhibitors (ICI), such as nivolumab, is associated with cardiotoxicity, with myocarditis being the most common. Patients often present with symptoms such as shortness of breath, palpitations, edema, and fatigue.

In addition, takotsubo cardiomyopathy, or broken heart syndrome, is characterized by systolic dysfunction of the left ventricle. This condition is similar to a myocardial infarction but without the associated coronary ischaemia and with minimal cardiac enzyme elevation.

The CHECKMATE-037 trial reported the incidence of ventricular arrhythmias in <10 percent of patients who received nivolumab. Furthermore, a retrospective study of patients treated with ICI (ie, nivolumab monotherapy) for lung cancer documented 11 percent of patients who developed major adverse cardiac events, such as myocarditis, non-STEMI, supraventricular tachycardia, and pericardial disorders.

"ICIs upregulate host antitumour immunity, proving efficacy across diverse tumour types,” according to the investigators. “Currently approved ICI treatment primarily targets the programmed cell death receptor 1 (PD-1) and its ligand PD-L1, and cytotoxic T lymphocyte-antigen 4.” 

“Nivolumab is a monoclonal antibody that targets the human PD-1 receptor and is an entirely human immunoglobulin G4, approved by the FDA for various cancers like advanced melanoma, metastatic renal cell carcinoma, Hodgkin lymphoma, and advanced lung carcinoma,” they added.