The Mechanism and Management of Adverse Cardiac Reactions Induced by Immune Checkpoint Inhibitors Therapy

Table 1

Management of cardiovascular irAEs in patients treated with ICIs [28].

Grading

Management method

G1, abnormal detection of cardiac biomarkers, including abnormal ECG; G2,  abnormal screening with mild symptoms; G3, moderate abnormal test or mild activity symptoms; G4, moderate to severe decompensation, requiring intravenous medication or intervention, life-threatening condition

Patients of all levels should consider the possibility of heart damage and conduct examinations and interventions, mainly considering the following points: (i) Suspend or terminate ICIs treatment above G1 level; (ii) Use of high-dose corticosteroids (prednisone 1-2 mg/kg) (oral or intravenous depending on symptoms); (iii) Manage cardiac symptoms according to ACC/AHA guidelines and under the guidance of cardiology; (iv) Patients with elevated troponin or abnormal conduction are immediately transferred to the coronary care unit; In patients who do not respond immediately to high-dose corticosteroids, consider an early heart transplant rejection dose of corticosteroids (methylprednisolone 1g per day), plus mycophenolate, infliximab, or antithymus cytoglobulin