Cardiotoxicity of T cell immunotherapies.

This publication is a narrative review focused on cardiovascular complications associated with T cell–based cancer immunotherapies, particularly cytokine release syndrome (CRS) and its cardiac sequelae.

Key points:

• • Scope of therapies covered: Discusses CAR T cells in depth, and also addresses bispecific antibodies, TCR-engineered T cells, and tumour-infiltrating lymphocyte (TIL) therapies as they move into broader clinical use.
• • Pathophysiology of CRS and cardiotoxicity: Explains how T cell activation leads to high-level cytokine release and systemic inflammation. This inflammatory cascade can precipitate cardiovascular events, analogous to other hyperinflammatory states.
• • Cardiovascular manifestations: Describes CRS-associated cardiac complications including arrhythmias, myocardial infarction, and heart failure. Among patients with high-grade CRS, cardiovascular events can occur in up to roughly one in five.
• • Epidemiology and risk context: Summarizes available data on the frequency and spectrum of cardiovascular events across T cell therapies, emphasizing that risk is closely tied to CRS severity.
• • Management strategies: Reviews current approaches to CRS treatment (e.g., anti-cytokine therapies and supportive care) and how early recognition and treatment of CRS can mitigate downstream cardiac injury. Highlights the importance of multidisciplinary cardio-oncology involvement.
• • Future directions: Suggests that deeper mechanistic understanding of T cell therapies and CRS biology will be key to refining risk stratification, surveillance, and prevention of cardiovascular toxicity as these therapies are used earlier and more broadly in oncology.