Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting

Autor: Melissa Y.Y. Moey, Cynthia R. Cherry, Paul R. Walker, Blase A. Carabello, Abdul Rafeh Naqash, Anna N. Tomdio, Justin D. McCallen, Lauren Vaughan, Kevin O'Brien
Rok vydání: 2020
Předmět:
lcsh:Diseases of the circulatory (Cardiovascular) system
Myocarditis
MACE
major adverse cardiac events
ICI
immune checkpoint inhibitor
Immune checkpoint inhibitors
NLR
neutrophil-to-lymphocyte ratio
Population
iRC
immune checkpoint inhibitor-related cardiotoxicity
lcsh:RC254-282
immune checkpoint inhibitors
CTLA-4
cytotoxicity T-cell lymphocyte antigen
neutrophil-to-lymphocyte ratio
NSCLC
non-small cell lung cancer
Medicine
irAE
immune-related adverse events
cardiovascular diseases
Neutrophil to lymphocyte ratio
education
Lung cancer
CTCAE
common terminology for clinical adverse events
Original Research
education.field_of_study
Cardiotoxicity
business.industry
fungi
Rural setting
food and beverages
Cancer
PD
programmed cell death
inflammatory markers
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
PD-L1
programmed cell death-ligand 1
Oncology
lcsh:RC666-701
Cancer research
myocarditis
Cardiology and Cardiovascular Medicine
business
CAR T
chimeric antigen receptor T cell
Zdroj: JACC. CardioOncology, Vol 2, Iss 3, Pp 491-502 (2020)
JACC: CardioOncology
ISSN: 2666-0873
DOI: 10.1016/j.jaccao.2020.07.005
Popis: Background Immune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is uncommon but can be fatal. There have been few reports of iRC from a rural cancer population and few data for iRC and inflammatory biomarkers. Objectives The purpose of this study was to characterize major adverse cardiac events (MACE) in ICI-treated lung cancer patients based in a rural setting and to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in the diagnosis of iRC. Methods Patients with lung cancer treated with ICIs at Vidant Medical Center/East Carolina University (VMC/ECU) between 2015 and 2018 were retrospectively identified. MACE included myocarditis, non-ST-segment elevated myocardial infarction (NSTEMI), supraventricular tachycardia (SVT), and pericardial disorders. Medical history, laboratory values, pre-ICI electrocardiography (ECG), and echocardiography results were compared in patients with and without MACE. Results Among 196 ICI-treated patients, 23 patients (11%) developed MACE at a median of 46 days from the first ICI infusion (interquartile range [IQR]: 17 to 83 days). Patients who developed MACE experienced myocarditis (n = 9), NSTEMI (n = 3), SVT (n = 7), and pericardial disorders (n = 4). Ejection fraction was not significantly different at the time of MACE compared to that at baseline (p = 0.495). Compared to baseline values, NLR (10.9 ± 8.3 vs. 20.7 ± 4.2, respectively; p = 0.032) and CRP (42.1 ± 10.1 mg/l vs. 109.9 ± 15.6 mg/l, respectively; p = 0.010) were significantly elevated at the time of MACE. Conclusions NLR and CRP were significantly elevated at the time of MACE compared to baseline values in ICI-treated patients. Larger datasets are needed to validate these findings and identify predictors of MACE that can be used in the diagnosis and management of ICI-related iRC.
Central Illustration
Databáze: OpenAIRE
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