{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:08:08Z","timestamp":1789729688047,"version":"4.0.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Primary cardiac tumors are rare, whereas cardiac metastases are more common forms of cardiac involvement in patients with advanced malignancies; both are clinically important because of their potential cardiovascular consequences. This review summarizes current evidence on the immune microenvironment, immune-evasion mechanisms, immunotherapeutic opportunities, multi-omics-based immune decoding, and cardiovascular toxicity in cardiac tumors and cardiac metastases. Cardiac myxoma is discussed as a benign primary cardiac tumor with inflammatory, cytokine-mediated, metabolic, and candidate immune-regulatory features, whereas malignant primary cardiac tumors, particularly cardiac sarcomas such as cardiac angiosarcoma, are reviewed in relation to immunosuppressive niches, macrophage-rich microenvironments, T-cell dysfunction, and heterogeneous responses to immune checkpoint inhibitors. Cardiac metastases are considered as a clinically relevant setting in which immunotherapy may be feasible for selected patients with careful cardiovascular assessment. Key mechanisms discussed include immune checkpoint pathways, tumor-associated macrophages, metabolic reprogramming, cytokine signaling, vascular abnormalities, and spatial immune organization. The review also highlights the role of single-cell sequencing, spatial transcriptomics, proteomics, metabolomics, and integrative multi-omics approaches in defining tumor-specific immune landscapes and potential biomarkers. Finally, immune checkpoint inhibitor-associated cardiotoxicity, particularly myocarditis, is discussed with emphasis on baseline cardiovascular assessment, biomarker monitoring, multimodality imaging, and multidisciplinary cardio-oncology management.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1877480","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:54:26Z","timestamp":1789728866000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardio-immuno-oncology in cardiac tumors and cardiac metastases: immune microenvironment, therapeutic opportunities, and cardiotoxicity"],"prefix":"10.3389","volume":"17","author":[{"given":"Hao","family":"He","sequence":"first","affiliation":[{"name":"Department of Cardiology, Shenzhen Longgang Second People\u2019s Hospital","place":["Shenzhen, Guangdong, 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