ARNIs treatment was associated with improved overall survival in lung cancer patients with hypertension treated with ICIs (89.7% vs. 66.7%, HR = 0.27).
Does angiotensin receptor-neprilysin inhibitors reduce all-cause mortality and cardiovascular events in lung cancer patients with hypertension undergoing immune checkpoint inhibitors treatment?
In lung cancer patients with hypertension undergoing immune checkpoint inhibitor therapy, the use of ARNIs was associated with significantly lower all-cause mortality compared to other antihypertensives.
Absolute Event Rate: 0% vs 0%
Background Angiotensin receptor-neprilysin inhibitors (ARNIs) could improve the outcome of patients with hypertension or heart failure. Yet it remains unclear if such protective effect exists in lung cancer patients with hypertension undergoing immune checkpoint inhibitors (ICIs). Objective This study sought to evaluate the impact of ARNIs on the outcome of lung cancer patients with hypertension treated with ICIs. Methods We performed a retrospective analysis of lung cancer patients with concurrent hypertension undergoing ICIs treatment between September 2019 and May 2024 in Shanghai Chest Hospital. The overall population included patients with or without ARNIs therapy. The primary endpoint was all-cause mortality and the secondary endpoint was a composite of cardiovascular events, including myocarditis, heart failure (HF), acute coronary syndrome (ACS), pericardial effusion (PE), and new-onset arrhythmias. Results The study enrolled 153 patients, with 39 (25.5%) patients in ARNIs group and 114 (74.5%) patients in control group. Over a median follow-up of 12 months, 42 (27.5%) patients died, ARNIs treatment was significantly associated with improved overall survival for lung cancer patients with hypertension and treated with ICIs (89.7% vs. 66.7%, HR = 0.27; 95% CI 0.10–0.75, log-rank P = 0.007). However, there was no significant difference in cardiovascular outcome between ARNIs and control group (21/114, 18.4% vs. 3/39, 7.7%, P = 0.112). During follow-up, a total of 24 cardiovascular adverse events occurred, of which the most common cardiovascular event was new-onset arrhythmia in both ARNIs group (2/3, 66.7%) and control group (14/21, 66.7%). Conclusions The use of ARNIs seemed associated with a lower all-cause mortality rate yet similar rate of cardiac events in lung cancer patients with hypertension and treated with ICIs. The findings of this single-center retrospective study warrant validation in larger prospective studies.
Shang et al. (Sat,) reported a other. ARNIs treatment was associated with improved overall survival in lung cancer patients with hypertension treated with ICIs (89.7% vs. 66.7%, HR = 0.27).