Cardiotoxicity with immune system targeting drugs: A meta-analysis of anti-PD/PD-L1 immunotherapy randomized clinical trials

Mohamed Rahouma, Nagla Abdel Karim, Massimo Baudo, Maha Yahia, Mohamed Kamel, Ihab Eldessouki, Ahmed Abouarab, Ihab Saad, Adham Elmously, Katherine D. Gray, Galal Ghaly, Ola Gaber, Mona Kamal, Ayah A Hassan, Mostafa Rahouma, Fabrizio D'Ascenzo, John Morris, Abdelrahman Mohamed, Leonard Girardi, Mario Gaudino

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations


Background: With antiprogrammed death receptor-1 (anti-PD-L1) therapy, a recent meta-analysis reported higher incidence of cutaneous, endocrine and gastrointestinal complications especially with dual anti-PD-L1 immunotherapy (IMM). Methods: Our primary outcome was assessment of all cardiotoxicity grades in IMM compared with different treatments, thus a systemic review and a meta-analysis on randomized clinical trials (RCTs) were done. Results: We included 11 RCTs with 6574 patients (3234 patients in IMM arm vs 3340 patients in the other arm). Three non-small-cell lung cancer RCTs, seven melanoma RCTs and only one prostatic cancer RCT met the inclusion criteria. There were five RCTs that compared monoimmunotherapy to chemotherapy "(n = 2631 patients)". No difference exists in all cardiotoxicity grades or high-grade cardiotoxicity (p > 0.05). Lung cancer exhibited a higher response rate and lower mortality in IMM. Conclusion: There was no reported statistically significant cardiotoxicity associated with anti-PD/PD-L1 use. Lung cancer subgroups showed better response and survival rates.

Original languageEnglish (US)
Pages (from-to)725-735
Number of pages11
Issue number8
StatePublished - May 15 2019
Externally publishedYes


  • anti-PD/PDL 1
  • cardiotoxicity
  • chemotherapy
  • immune system targeting drugs
  • immunotherapy
  • lung cancer
  • meta-analysis
  • randomized clinical trials

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Oncology


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