IMMUNOTHERAPY AND CARDIOTOXICITY: DIAGNOSTIC AND TREATMENT STRATEGIES

Abstract

Immunotherapy of malignant neoplasms, primarily with immune checkpoint inhibitors, has transformed the landscape of oncology care over the past ten years, including in the Russian Federation.

As indications for and the number of patients receiving immuno-oncology drugs expand, the problem of cardiotoxicity, including myocarditis, pericarditis, acute coronary syndromes, arrhythmias, and heart failure, has come to the forefront.

This article summarizes data from international and Russian studies conducted in 2022–2024 on the incidence and structure of cardiotoxic complications of immunotherapy. The mechanisms of myocardial injury are discussed. Modern approaches to diagnostics and monitoring are presented, including the role of biomarkers (troponin, natriuretic peptides), imaging techniques (echocardiography, cardiac MRI), and risk stratification. Particular attention is paid to the Russian context: the rising incidence of cancer (624,835 new cases of malignant neoplasms in the Russian Federation), the expansion of the network of centers using antitumor immunotherapy (more than 135 clinics in 52 Russian cities offer these treatments), the development of cardio-oncology services, and expert documents on the prevention and treatment of cardiotoxicity.

Based on a literature review, optimal strategies for managing patients receiving immune checkpoint inhibitors are discussed, focusing on early detection of cardiotoxicity, treatment algorithms (glucocorticosteroids and other immunosuppressants), and the organization of oncologist-cardiologist collaboration.