Key result
Immune checkpoint inhibitor therapy in cancer patients was associated with a significantly lower risk of non-fatal stroke compared to non-ICI therapy (sub-HR 0.59), with no significant increase in other major cardiovascular events.
Why the study?
Immune checkpoint inhibitors have revolutionized cancer therapy, but their cardiovascular risks compared to non-ICI therapies required examination.
Do immune checkpoint inhibitors increase the risk of cardiovascular events and venous thromboembolism in cancer patients compared to non-ICI therapies?
Cohort (n=3,428)
Yes
Do immune checkpoint inhibitors increase the risk of cardiovascular events and venous thromboembolism in cancer patients compared to non-ICI therapies?
In a large retrospective cohort, immune checkpoint inhibitors did not increase cardiovascular or VTE risks in cancer patients and were associated with a reduced risk of non-fatal stroke.
BACKGROUND: Immune Checkpoint Inhibitors (ICIs) have revolutionized cancer therapy. This study examines the cardiovascular risks of ICIs compared to non-ICI therapies. METHODS: Utilizing the Chang Gung Research Database (CGRD) of Taiwan, this retrospective study analyzed 188,225 cancer patients, with 1,737 undergoing ICI treatment from January 1, 2008, to June 30, 2021. Through 1:1 propensity score matching (PSM), we compared specific outcomes between patients treated with ICIs and those who were not. The analysis also accounted for the competing risk of mortality in assessing the results after PSM. The observation period spanned from this index date to whichever came first: the date of the specific outcomes, the last follow-up recorded, or the end date of the study on June 30, 2022. RESULTS: The study found no significant increase in the risk of cardiac death, non-fatal myocardial infarction, heart failure hospitalization, deep vein thrombosis, or pulmonary embolism in patients treated with ICIs as compared to those receiving non-ICI therapy. Interestingly, ICI treatment was linked to a lower risk of non-fatal stroke (0.27% per year vs. 0.46% per year; subdistribution hazard ratio = 0.59; 95% confidence interval = 0.35-0.98; P = 0.0430). Furthermore, subgroup analysis revealed that the ICI group had a decreased risk of cardiac death in patients with cancers other than head and neck cancer, and a reduced risk of stroke among diabetic patients. CONCLUSIONS: ICIs do not significantly elevate the risk of cardiovascular events in cancer patients and may lower the stroke risk, underscoring the need for additional prospective studies to clarify these findings.
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Peng et al. (2024) conducted a cohort in Cancer (n=3,428). Immune Checkpoint Inhibitors (ICIs) vs. Non-ICI therapy was evaluated on Non-fatal stroke (sub-HR 0.59, 95% CI 0.35-0.98, p=0.0430). Immune checkpoint inhibitor therapy in cancer patients was associated with a significantly lower risk of non-fatal stroke compared to non-ICI therapy (sub-HR 0.59), with no significant increase in other major cardiovascular events.
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