Immuno-inflammatory mechanisms in cardio-oncology: new hopes for immunotargeted therapies 1

Meiqi Miao ¹ Xinxin Liu ² Han Zhang ^3* Hai-Long Dai ^3*

• ¹ Department of Cardiology, Kunshan Traditional Chinese Medicine Hospital, Kunshan, China
• ² Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
• ³ Yan'an Hospital Affiliated To Kunming Medical University, Kunming, Yunnan Province, China

Cardio-oncology is an emerging interdisciplinary field concerned with cancer treatment-related cardiovascular toxicities (CTR-CVT) and concomitant cardiovascular diseases (CVD) in patients with cancer. Inflammation and immune system dysregulation are common features of tumors and cardiovascular disease (CVD). In addition to the mutual exacerbating effect through inflammation, tumor treatments, including immunotherapy, chemotherapy, radiation therapy, and targeted therapy, may induce immune inflammatory reactions leading to cardiovascular damage. Cancer immunotherapy is currently a new method of cancer treatment. Immunotherapeutic agents, such as immune checkpoint inhibitors (ICIs), chimeric antigen receptor T cell immunotherapy (CAR-T), mRNA vaccines, etc., can induce anti-tumor effects by enhancing the host immune response to eliminate tumor cells. They have achieved remarkable therapeutic efficacy in clinical settings but lead to many immune-related adverse events (irAEs), especially CTR-CVT. Establishing specific evaluation, diagnostic, and monitoring criteria (e.g., inflammatory biomarkers) for both immunotherapy and anti-inflammatory therapy-related cardiovascular toxicity is vital to guide clinical practice. This article explores the role of immune response and inflammation in 3 tumor cardiology, unravels the underlying mechanisms, and provides improved methods for 36 monitoring and treating in CTR-CVT in the field of cardio-oncology. 37 4 Highlights.  CVDs are common complications of antineoplastic therapy, and they have shared risk factors with tumors.  Increased inflammatory risk has a significant adverse effect on oncological cardiology-related markers, such as CTR-CVT.  The "immune-inflammatory" mechanisms in CTR-CVT and tumor-associated cardiovascular complications are critical for patients' safety, outcome, and prognosis.  Inflammatory biomarkers can help assess the severity of CTR-CVT and reduce CVD incidence in cancer patients. Targeted therapy based on immune-inflammatory mechanisms holds promise for future treatment approaches in the field of cardio-oncology.