p.45 抽出テキスト
5.5.9 Immune checkpoint inhibitors Immunotherapies, which harness the immune system to destroy cancer cells, come in different forms but the most widely used are ICI.316 The immune checkpoints are proteins expressed in the T cells that inhibit their activation when they contact a body cell. ICI include monoclonal antibodies that block the immune brakes or regulators, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) (ipilimumab, tremelimumab), programmed death-1 (PD-1) (nivolumab, cemiplimab, pembrolizumab), and programmed death-ligand 1 (PD-L1) (atezolizumab, avelumab, durvalumab) expressed in the cancer cells, with the consequent cytotoxic immune response. By blocking these checkpoints from binding with their partner proteins, ICI inhibit the ‘off’ signal, activating T cells and promoting killing of cancer cells. Although their pathophysiology is not clearly defined, ICI may also trigger an Low risk cTn Class 1 Class 1Ia Class 1Ib ECG TTE CV assessmenta NP cTn ECG TTE CV assessmenta NP High riskb C4 Every 3Cc Every 6 M– 12 Md C2 C3 Baseline Immune checkpoint inhibitors surveillance protocol Figure 20 Cardiovascular surveillance in patients treated with immune checkpoint inhibitors. BNP, B-type natriuretic peptide; BP, blood pressure; C, chemotherapy cycle; cTn, cardiac troponin; CV, cardiovascular; CVD, cardiovascular disease; CTRCD, cancer therapy-related cardiac dysfunction; ECG, electrocardiogram; HbA1c, glycated haemoglobin; ICI, immune checkpoint inhibitors; M, months; NP, natriuretic peptides (including BNP and NT-proBNP); NT-proBNP, N-terminal pro-B-type natriuretic peptide; TTE, transthoracic echocardiography. aIncluding physical examination, BP, lipid profile, and HbA1c. bDual ICI, combination ICI-cardiotoxic therapy, ICI-related non-CV events, prior CTRCD or CVD. cEvery three cycles until completion of therapy to detect subclinical ICI-related CV toxicity. dIn patients who require long-term (.12 months) ICI treatment. Downloaded from academic.oup.com/eurheartj/article/43/41/4229/6673995 by guest on 07 October 2026