This summer, I lost a very dear patient of mine for whom I had cared for over 10 years. He had a number of chronic comorbidities—renal insufficiency, diabetes, hypertension, heart failure with preserved ejection fraction, and morbid obesity. He developed metastatic renal cell carcinoma and did not tolerate multiple VEGFR tyrosine kinase inhibitors secondary to treatment-related toxicity, including worsening renal dysfunction and malignant hypertension. Despite intensive and careful management, his disease progressed. He was treated with immune checkpoint inhibitor therapy and subsequently developed severe pneumonitis and myocarditis, which gradually resolved with high-dose steroid therapy, but treatment was discontinued because of these toxicities. After a long year of worsening disease, he passed away. I often find myself hoping for evidence-based strategies that could have prevented his treatment-related toxicities and reversed his disease course.
Immune therapy has fundamentally changed the landscape of cancer treatment, and has been a remarkable, paradigm-shifting advance in modern medicine. Along with surgery, radiation, chemotherapy, and targeted therapy, immune therapy is now one of the pillars of cancer therapy. Immune checkpoint inhibitors have indications in adjuvant and neoadjuvant cancer treatment in over 20 different cancers.1 Chimeric antigen receptor T-cell therapies are also approved and in use for the treatment of hematologic malignancies. Additional novel immune-based therapies, including tumor-infiltrating lymphocyte therapies, vaccines, and bispecific engagers, are under active investigation.2 The relevance of chimeric antigen receptor T therapies to prevent and treat cardiovascular disease is an emerging area of new science, which we hope will continue to fuel new therapeutic discovery.3
In this issue of JACC: CardioOncology dedicated entirely to Immune Therapy, we include state-of-the-art reviews, primers, original research, clinical case challenges, and viewpoints to provide the most current, evidence-based science, clinical experiences, and knowledge for our community. We present both the cardiovascular and oncologic perspective, and focus on clinical and basic science data to inform the epidemiology and mechanisms of cancer and cardiovascular disease. While we recognize that actionable science and our clinical experiences are continuously formulated, we hope that this issue will serve as your go-to resource as we seek to motivate evidence-based, empathic care for our patients and stimulate new science to advance cardiovascular and oncologic health.
References
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