Immune Checkpoint Inhibitor Cardiotoxicity: Contributing Factors, Appropriate Treatments, and Retreatment Options


Kerry L. Reynolds, MD
Assistant Professor of Medicine Harvard Medical School
Director, Severe Immunotherapy Complications (SIC) Service
Clinical Director, Inpatient Cancer Services, Massachusetts General Hospital Cancer Center
Boston, MA
Kerry L. Reynolds, MD

Dr. Kerry Reynolds is an oncologist at the Massachusetts General Hospital Cancer Center and Assistant Professor of Medicine at Harvard Medical School. She currently serves as the Director of the Severe Immunotherapy Complications (SIC) Service and the Clinical Director for Inpatient Cancer Services at Mass General Cancer Center. She joined the Harvard Medical School faculty in 2014, after completing her residency and chief residency at Massachusetts General and fellowship training in Oncology at Dana-Farber/Partners Cancer Care.

The SIC Service is the first program of its kind in the country. Every hospitalized patient at Mass General Cancer Center who has received immunotherapy and is suspected to be experiencing an immune-related adverse event (irAE) is seen by one of the Service’s dedicated oncologists, resulting in unparalleled care for this type of toxicity. Under the leadership of Dr. Reynolds, the SIC Service now provides care to a significant number of patients every year and has grown to comprise more than 50 clinicians and researchers across 19 different areas of the hospital, including subspecialists from oncology, cardiology, dermatology, gastroenterology, and many more relevant disciplines.

In addition to providing clinical care, supervising and educating trainees, and participating in administrative affairs, Dr. Reynolds leverages the work of the SIC Service to conduct research on the severe toxicities associated with immunotherapy. Her ultimate goal is to improve the lives of patients undergoing immunotherapy by uncovering irAE predictors and biomarkers, characterizing the clinical presentations of irAEs, developing best practices for managing irAEs, and elucidating the mechanisms that drive irAEs in order to develop novel therapies. To pursue this goal, she is working with Dr. Alexandra-Chloe Villani to systematically collect blood and tissue samples from patients with irAEs and analyze them using cutting-edge technologies. Dr. Reynolds has also authored numerous peer-reviewed publications and several book chapters, and she was lead editor of Facing Immunotherapy: A Guide for Patients and Their Families.

Tomas G. Neilan, MD, MPH
Associate Professor of Medicine, Harvard Medical School
Director, Cardio-Oncology Program, Co-Director, Cardiovascular Imaging Research Program, Massachusetts General Hospital, Boston, MA
Tomas G. Neilan, MD, MPH

Dr. Neilan received his MD from University College Dublin and MPH from Harvard School of Public Health. He completed internal medicine residency and cardiology training at the Mater Misericordiae Hospital in Dublin and again at Massachusetts General Hospital. He has also completed extensive training in echocardiography at Massachusetts General Hospital and in cardiac magnetic resonance at the Brigham and Women’s Hospital. Dr. Neilan is an Associate Professor of Medicine at Harvard Medical School, the Director of the Cardio-Oncology Program, and the Co-Director of the Cardiac MR PET CT Program.

Dr. Neilan has had a long-standing clinical and research interest in the cardiovascular care of patients with cancer. Cardiovascular disease is a leading cause of death and disability among cancer survivors and cardiovascular care for patients with cancer requires a tailored approach that is unique for each patient. He is specifically interested in how we can improve on the methods for detection of cardiac toxicity after chemotherapy and radiotherapy and to use that information to determine how we care for patients.

Statement of Need

Immune checkpoint inhibitors (ICIs) have permanently changed the landscape of cancer therapy. However, up to half of patients who receive ICIs experience immune-related adverse events (irAEs), and some portion (1-2%, perhaps more) experience cardiotoxicity, such as myocarditis or other cardiovascular events. Recognizing ICI-related cardiotoxicity and initiating prompt treatment is critical. Whether to restart these patients on ICIs is controversial. ICI-related cardiotoxicity is rare, but clear guidelines to screen and treat CV toxicity are lacking, and clinicians need education on cardiotoxic effects of ICI therapy and guidance on rechallenging with ICI therapy.

This initiative seeks to fill those knowledge gaps among cardiologists and clinicians caring for patients with cancer who receive ICI therapy. Clinicians will receive education on the available clinical evidence to make informed decisions regarding resumption of therapy.

Learning Objectives

At the end of this CME/CE activity, participants should be able to:

  • Summarize factors contributing to cardiotoxicity associated with ICI use.
  • Differentiate risk of outcome severity in patients after experiencing ICI-related cardiotoxicity.
  • Select appropriate treatment approaches for ICI-related cardiotoxicity.
  • Appraise current clinical evidence for and against ICI rechallenge in patients experiencing CV AEs after ICI therapy.

Financial Support

Supported by educational grant from Bristol Myers Squibb.

Target Audience

Cardiologists, oncologists, PCPs, physician associates (PAs), nurse practitioners (NPs), nurses, and pharmacists

Credit Information

Jointly Accredited Provider

In support of improving patient care, CME Outfitters, LLC, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Interprofessional (IPCE) 1.0

This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) Credit for learning and change.

Physicians (ACCME) 1.0

CME Outfitters, LLC, designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses (ANCC) 1.0

This activity is designated for 1.0 contact hour.

Note for California Nurses

This continuing nursing education activity was approved by the California Board of Registered Nursing. CME Outfitters, LLC’s provider number is CEP15510.

Pharmacists (ACPE) 1.0

This application-based activity is approved for 1.0 contact hour (0.10 CEUs) of continuing pharmacy credit.
Activity UAN: JA0007185-0000-22-160-H01-P

Physician Assistants (AAPA): 1.0

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Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 medical knowledge MOC point in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Royal College MOC

Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

MIPS Improvement Activity

Completion of this accredited CME activity meets the expectations of an Accredited Safety or Quality Improvement Program (IA_PSPA_28) for the Merit-based Incentive Payment Program (MIPS). Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Reynolds reports the following financial relationships: Research Support: Project Data Sphere (a non-profit company). Stock Shareholder (ownership interest): Biogen. Other Financial or Material Support: (ownership interest): Teledoc Health, Inc.

Dr. Neilan reports the following financial relationships: Consultant: AbbVie Inc.; Bristol Myers Squibb; CRO Oncology; C4-Therapeutics, Inc.; Genentech, Inc.; Roche; and Sanofi. Grants: AstraZeneca and Bristol Myers Squibb

The following peer reviewer and CME Outfitters staff have no financial relationships:

  • Michael Franks, APRN, AGACNP-BC, FNP-BC (peer reviewer)
  • Thomas Mitchell (planning committee)
  • David Modrak, PhD (planning committee)
  • Susan H. Yarbrough, CHCP (planning committee)
  • Sandra Caballero, PharmD (planning committee)
  • Sharon Tordoff (planning committee)

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Obtaining Credits

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Immune Checkpoint Inhibitor Cardiotoxicity: Contributing Factors, Appropriate Treatments, and Retreatment Options
Event Date: 12/28/2022 at 5:00 am EST