Immune Checkpoint Inhibitor-Related Adverse Cardiovascular Events in Patients With Lung Cancer

Autor: Eric H. Bernicker, I. Hussain, Arvind Bhimaraj, Raquel Araujo-Gutierrez, DO Kalyan R. Chitturi, Jiaqiong Xu, Ashrith Guha, Barry H. Trachtenberg, Mahwash Kassi
Rok vydání: 2019
Předmět:
Oncology
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty
PD
programmed cell death protein
ICI
immune checkpoint inhibitor
cardiotoxicity
MACE
lcsh:RC254-282
TKI
tyrosine kinase inhibitor
immune checkpoint inhibitors
Internal medicine
LVEF
left ventricular ejection fraction
Troponin I
medicine
Clinical endpoint
cardiovascular diseases
Myocardial infarction
Adverse effect
Lung cancer
BNP
B-type natriuretic peptide
IQR
interquartile range
Original Research
Cardiotoxicity
troponin
business.industry
Hazard ratio
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
HR
hazard ratio
VEGFI
vascular endothelial growth factor inhibitor
CI
confidence interval
lung cancer
PD-L1
programmed cell death-ligand 1
lcsh:RC666-701
MACE
major adverse cardiovascular events
TnI
troponin I
Cardiology and Cardiovascular Medicine
business
Mace
BNP
Zdroj: JACC: CardioOncology
JACC. CardioOncology, Vol 1, Iss 2, Pp 182-192 (2019)
ISSN: 2666-0873
DOI: 10.1016/j.jaccao.2019.11.013
Popis: Objectives The purpose of this study was to evaluate whether immune checkpoint inhibitors (ICIs) are associated with an increased risk of major adverse cardiovascular events (MACE) compared with non-ICI therapies in patients with lung cancer. Background ICIs activate the host immune system to target cancer cells. Though uncommon, cardiovascular immune-related adverse events can be life-threatening. Methods A retrospective single-institution cohort study of 252 patients with pathologically confirmed lung cancer who received ICI or non-ICI therapy was analyzed. The primary endpoint was MACE, defined as a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure. Results During a median follow-up of 6 months, MACE occurred in 13.3% of ICI-treated patients, with a median time to event of 51 days, compared with 10.3% and 64 days in non-ICI patients. ICIs were not associated with MACE (hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.57 to 2.43; p = 0.66) in a univariable Fine-Gray regression analysis incorporating noncardiovascular death as a competing risk. Multivariable regression analyses determined that patients treated with ICIs with elevated serum troponin I >0.01 ng/ml (HR: 7.27; 95% CI: 2.72 to 19.43; p < 0.001) and B-type natriuretic peptide (BNP) >100 pg/ml (HR: 2.65; 95% CI: 1.01 to 6.92; p = 0.047) had an increased risk of MACE. Patients pre-treated or receiving combined immunotherapy with ICIs and vascular endothelial growth factor inhibitors (VEGFIs) or tyrosine kinase inhibitors (TKIs) had an increased risk of MACE (HR: 2.15; 95% CI: 1.05 to 4.37; p = 0.04). Conclusions ICIs were not independently associated with an increased risk of MACE in patients with lung cancer, although power is an important limitation in these analyses. ICI-associated cardiotoxicity was associated with elevations in serum troponin and BNP, and combined immunotherapy with VEGFIs or TKIs. Future studies are needed to further define the role of cardiac biomarkers as a monitoring strategy with ICI therapy.
Central Illustration
Databáze: OpenAIRE
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