CAR-T-cell cancer therapy uses special T-cells that are specifically directed towards tumor antigens, the so-called (CAR)-T-cells. These cells trigger a targeted immune response that helps the body recognize and fight cancer cells. But, like other cancer therapies, the treatment can cause unwanted side effects, such as affecting heart function.

Scientists from the Medical Faculty of the University of Duisburg-Essen and the University Medicine Essen have now taken a closer look at the changes that CAR T cell cancer therapy can cause in the cardiovascular system and published them in the renowned European European Heart Journal.

One of the possible side effects is a systemic inflammatory reaction in which messenger substances are increasingly released throughout the body. This can cause mild flu-like symptoms, but can also lead to serious complications such as multiple organ failure. “Until now it was unclear to what extent this inflammatory reaction also affects the cardiovascular system,” explains Prof. Dr. Tienush Rassaf, Director of the Department of Cardiology and Angiology at Essen University Medicine.

Reduced blood flow in the heart tissue, vascular occlusions and heart failure

The research team has now been able to show that the released neurotransmitters often cause an increased heart rate and low blood pressure, but also ventricular fibrillation and cardiac arrhythmia. “These symptoms also occur with other, comparable inflammatory reactions,” says Prof. Rassaf. However, the researchers have also observed serious complications. Reduced blood flow in the heart tissue, vascular occlusions and heart failure occur during CAR-T cell therapy, especially in pre-existing patients. CAR-T cell therapy is currently approved for some blood cancers, but is also being tested for solid tumors.

Keep an eye on the changes in cardiac function if you are already stressed 

“Our work is intended to help physicians keep an eye on changes in cardiac function, especially in patients with preexisting conditions, and to be able to initiate appropriate treatments at an early stage,” says Prof. Dr. Matthias Totzeck, senior medical director of oncological cardiology in the clinic for cardiology and angiology.

The publication provides an overview of current CAR T cell therapies and possible undesirable side effects. The authors focus on cardiovascular symptoms, summarize the current knowledge on the underlying pathomechanisms and explain clinical characteristics. They also provide recommendations on how CAR-T cell therapy should be appropriately monitored by cardiologists.

original publication

Cardiotoxicity from chimeric antigen receptor-T cell therapy for advanced malignancies 
Matthias Totzeck, Lars Michel, Yi Lin, Joerg Herrmann, Tienush Rassaf
European Heart Journal , ehac106,  https://doi.org/10.1093/eurheartj/ehac106