Cardiovascular toxicity profile of immune response checkpoint inhibitors

The introduction of immune response checkpoint inhibitors is a step toward an innovative treatment paradigm, but along with increased antitumor efficacy may come a potential increase in cardiotoxicity. Objective. To study the frequency of clinical manifestations of early cardiovascular toxicity during IcT administration in patients with malignant neoplasms. Materials and methods. 47 patients (27 men, 20 women), mean age 59,5±7,38 years were included in the prospective study. clinical cardiovascular symptoms, dynamics of blood pressure, laboratory parameters (c-reactive protein (crP), troponin I, n-terminal fragment of brain natriuretic peptide precursor (nT-proBnP), electrocardiogram and echocardiography data initially and in the dynamics of antitumor drug treatment in 3 months or earlier, at the onset of cardiovascular symptoms, were analyzed. Results. during the follow-up period, the incidence of adverse clinical cardiovascular events was 17.6% (n=6). Atrial fibrillation first manifested in 5.8% (n=2), symptoms of heart failure – in 8.8% (n=3), 2.9% (n=1) developed acute cerebral circulatory failure. In 3 patients (8.8%) cardiovascular manifestations were combined with lack of arterial hypertension control, which required correction of hypotensive therapy. moderate cardiac dysfunction developed in 5.9% (n=2) of patients, in 2.9% (n=1) – mild myocardial dysfunction according to ecHocG-criteria and changes in the level of biomarkers. There was a tendency to increase nT-proBnP level (p=0.051), crP level (p=0.05). There was a statistically significant decrease in LVeF (p=0.02). manifestation of cardiovascular complications in patients with malignant neoplasms against the background of IcT therapy was associated with age (β=0.32; p=0.07), crP level (β=0.46; r2=0.22; p=0.005) (model – multiple linear regression). Conclusions. First-time cardiovascular complications on the background of therapy of malignant neoplasms with checkpoint inhibitors are detected with high frequency (17.6%), characterized by a decrease in left ventricular ejection fraction, associated with the level of c-reactive protein and age of patients.