A narrative review of immune checkpoint inhibitor-related cardiotoxicity in lung cancer: mechanisms, risk stratification, and clinical management.

Authors

Yongyan Shen, Hui Li, Xinyue Wang, Heping Sun, Rui Zhong, Shaowei Lan, Chenchen Tang, Shoulin Zhang

Published in

Journal of thoracic disease. Volume 18. Issue 8. Pages 961. Aug 31, 2026. Epub Jul 21, 2026.

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced lung cancer. However, their associated cardiac toxicity constitutes a life-threatening immune-related adverse reaction, with myocarditis being the most severe form, carrying a mortality rate of nearly 40%. Patients with lung cancer face a distinctively higher risk of ICI-related cardiotoxicity compared with other malignancies, driven by lung cancer-specific factors including tumor microenvironment hypoxia and fibrosis, prior thoracic radiotherapy, smoking-related comorbidities, and potential antigen cross-reactivity. Given the unique high-risk profile of ICI-related cardiac injury in lung cancer patients, this review integrates multidisciplinary clinical evidence and translational research findings to provide practical and forward-looking strategies for the standardized management of ICI-related cardiac toxicity. Furthermore, this study emphasizes risk stratification and the exploration of underlying mechanisms, proposing feasible research directions to promote the optimization of the balance between efficacy and safety in lung cancer immunotherapy, thereby providing a sound reference for the further development of cardiac oncology practice in lung cancer.
A narrative review was conducted using literature retrieved from PubMed, ClinicalTrials.gov, the Chinese Clinical Trial Registry (ChiCTR), and Google Scholar, covering the period from January 2000 to March 2026. Search topics focused on ICI related targets, various lung cancer subtypes, and associated cardiovascular and immune-related adverse events (irAEs). Original research articles, reviews, clinical trials, and case reports focusing on ICI-related cardiac toxicity in patients with lung cancer were included. To ensure comprehensiveness and minimize omissions, relevant abstracts from the 2020 to 2026 meetings of the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO) and the World Conference on Lung Cancer (WCLC) were manually screened, and reference lists of included studies were cross-checked to identify additional eligible literature.
This review synthesizes current evidence on the epidemiology, clinical features, and mechanisms of ICI-related cardiotoxicity specifically in lung cancer, with an emphasis on how lung cancer-specific pathophysiological features amplify susceptibility to immune-mediated cardiac injury. We summarize key biomarkers and predictive models for early detection and risk stratification and propose a practical clinical management framework tailored to this high-risk population.
Although ICI immunotherapy has significantly improved survival outcomes in patients with advanced lung cancer, ICI-related cardiovascular toxicity remains a critical and life-threatening clinical challenge. Optimizing biomarker monitoring, accurate risk stratification and standardized cardiological management are essential for reducing adverse cardiac events and improving the long-term prognosis of lung cancer patients receiving immunotherapy.

PMID:
42724286
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.

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