Immune checkpoint inhibitors were not associated with an increased risk of MACE compared with non-ICI therapies in patients with lung cancer (HR 1.18; 95% CI 0.57 to 2.43; p=0.66).
Cohort (n=252)
No
Do immune checkpoint inhibitors increase the risk of major adverse cardiovascular events in patients with lung cancer compared to non-ICI therapies?
In patients with lung cancer, immune checkpoint inhibitors were not independently associated with an increased risk of MACE, though elevated cardiac biomarkers and concurrent use of VEGFIs or TKIs identified a higher-risk subgroup.
Hazard Ratio: 1.18 (95% CI 0.57–2.43)
Absolute Event Rate: 13.3% vs 10.3%
p-value: p=0.66
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 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.
Chitturi et al. (Sun,) conducted a cohort in Lung cancer (n=252). Immune checkpoint inhibitors (ICIs) vs. Non-ICI therapies was evaluated on MACE, defined as a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure (HR 1.18, 95% CI 0.57 to 2.43, p=0.66). Immune checkpoint inhibitors were not associated with an increased risk of MACE compared with non-ICI therapies in patients with lung cancer (HR 1.18; 95% CI 0.57 to 2.43; p=0.66).