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Clinical Review State of the Art Review

Cardiovascular toxicity of immune therapies for cancer

BMJ 2024; 385 doi: (Published 15 May 2024) Cite this as: BMJ 2024;385:e075859
  1. Nicolas L Palaskas, associate professor1,
  2. Hyeon-Ju Ali, assistant professor1,
  3. Efstratios Koutroumpakis, assistant professor1,
  4. Sarju Ganatra, assistant professor2,
  5. Anita Deswal, professor2
  1. 1University of Texas MD Anderson Cancer Center, Houston, TX, USA
  2. 2Lahey Hospital and Medical Center, Burlington, MA 01805
  1. Correspondence to: A Deswal adeswal{at}


In addition to conventional chemoradiation and targeted cancer therapy, the use of immune based therapies, specifically immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T cell therapy (CAR-T), has increased exponentially across a wide spectrum of cancers. This has been paralleled by recognition of off-target immune related adverse events that can affect almost any organ system including the cardiovascular system. The use of ICIs has been associated with myocarditis, a less common but highly fatal adverse effect, pericarditis and pericardial effusions, vasculitis, thromboembolism, and potentially accelerated atherosclerosis. CAR-T resulting in a systemic cytokine release syndrome has been associated with myriad cardiovascular consequences including arrhythmias, myocardial infarction, and heart failure. This review summarizes the current state of knowledge regarding adverse cardiovascular effects associated with ICIs and CAR-T.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: NLP did the initial literature search. AD and NLP conceptualized and designed the work. All authors provided drafts of assigned sections, which were compiled, and the manuscript was revised by all authors. NLP and AD made the final editorial changes and are the guarantors.

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: NLP is partly supported by the Cancer Prevention Research Institute of Texas (CPRIT) RP200670, NIH/NCI 1P01CA261669-01, and has served as a consultant for Kiniksa Pharmaceuticals and Replimmune; EK is supported in part by NIH/NCI 1RO1HL157273 and CPRIT RP200381; AD is supported in part by the Ting Tsung and Wei Fong Distinguished Chair, NIH/NCI 1RO1HL157273, and CPRIT RP200381 and has served as a consultant for Bayer.

  • Patient involvement: No patients were asked for input in the creation of this article.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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