Cardiovascular Immune-Related Adverse Events of Immune Checkpoint Inhibitors: A Systematic Review and Meta-Summary of Case Reports.

BACKGROUND: Reports of immune checkpoint inhibitor (ICI) therapy-associated immune-related adverse events (irAEs) exhibit considerable heterogeneity, particularly when comparing data from clinical trials and real-world observational studies. METHODS: We conducted a systematic review of real-world observational studies (case reports and series) reporting cardiovascular irAEs in PubMed and Embase from inception to April 1, 2024. We analyzed 116 case reports from 115 studies and highlighted the commonest irAEs, treatments instituted, and ensuing outcomes. RESULTS: Myocarditis was the most common, accompanied frequently by pericarditis and heart failure. Treatment typically included corticosteroids and discontinuation of ICI therapy. Higher doses of corticosteroids appeared promising. Refractory cases benefited from plasmapheresis, intravenous immunoglobulin, mycophenolate, tacrolimus, or infliximab. Rechallenging ICI therapy after irAEs resulted in mixed outcomes. CONCLUSIONS: Given the heterogeneity of data, analysis of aggregated data from central repositories like Side Effect Registry Immuno-Oncology (SERIO) would be invaluable.