Immunotherapy based on immune checkpoint inhibitors (ICIs) is currently broadly used in the treatment of different types of cancer. The treatment targeting programmed cell death protein 1/programmed death‐ligand 1 axis is already approved by Food and Drug Administration for numerous cancers. These kinds of therapy brought spectacular results in the treatment of non‐small cell lung cancer where systemic therapy was ineffective. However, a wide range of applied therapies based on ICIs in the clinic have led to unexpected side effects, such as severe cardiotoxicity. It needs to be underlined that the molecular mechanism of myocarditis in response to ICIs is still not fully understood. Lack of sufficient knowledge, especially concerning the kind of risk factors increasing probability of myocarditis, poses currently a large clinical problem. Continuous cardiac monitoring of patients who undergo ICI treatment presents another problem as it is cost‐ineffective for the healthcare system. Herein, we highlight the risks of use of anticancer therapy based on ICIs. We also stress that detailed monitoring of any event of cardiotoxicity following ICIs treatment should be carefully investigated and registered to give a global overview of the frequency of myocarditis occurrence. Moreover, we propose that the extension of molecular and systemic knowledge of etiology of myocarditis as a side effect, including the role of protein kinases, will be highly beneficial for the medical field. Last but not least, better understanding of mechanisms of cardiotoxicity induction will improve the safety of cancer patients and will help clinicians in prediction of unexpected side effect occurrence.

中文翻译：

---

免疫治疗中的心脏毒性危险

基于免疫检查点抑制剂（ICIs）的免疫疗法目前广泛用于治疗不同类型的癌症。针对程序性细胞死亡蛋白 1/程序性死亡配体 1 轴的治疗已被食品和药物管理局批准用于治疗多种癌症。这些疗法在全身治疗无效的非小细胞肺癌的治疗中取得了惊人的效果。然而，临床上基于 ICI 的广泛应用疗法导致了意想不到的副作用，例如严重的心脏毒性。需要强调的是，心肌炎响应 ICI 的分子机制仍未完全了解。缺乏足够的知识，尤其是关于增加心肌炎可能性的风险因素的种类，目前是一个很大的临床问题。对接受 ICI 治疗的患者进行连续心脏监测存在另一个问题，因为它对医疗保健系统来说成本效益低。在此，我们强调使用基于 ICI 的抗癌治疗的风险。我们还强调，应仔细调查和登记 ICIs 治疗后任何心脏毒性事件的详细监测，以提供心肌炎发生频率的全球概览。此外，我们建议扩展心肌炎病因学的分子和系统知识作为副作用，包括蛋白激酶的作用，将对医学领域非常有益。最后但并非最不重要的一点是，更好地了解心脏毒性诱导机制将提高癌症患者的安全性，并有助于临床医生预测意外副作用的发生。