What question did this study set out to answer?

To evaluate the incidence and identify demographic and clinical risk factors associated with cardiotoxic events in cancer patients treated with immune checkpoint inhibitors.

March 11, 2022Cardio-OncologyOpen Access

Cardiotoxicity risk factors with immune checkpoint inhibitors

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Why the study?

Cardiotoxicity of checkpoint inhibitors was observed in murine models and case reports, but the frequency and associated risk factors remained to be determined.

Do specific demographic and cardiovascular risk factors increase the risk of cardiotoxic events in patients treated with immune checkpoint inhibitors?

Population

538 patients treated with durvalumab, ipilimumab, nivolumab, or pembrolizumab at Wake Forest Baptist Health

Comparison

Cardiovascular risk factors and patient characteristics

Design

Retrospective medical record review

Authors

ZBZachary BrumbergerUniversity at Buffalo, State University of New York MBMary BranchCone Health MKMax W KleinCarilion Clinic

Discussion

Member takes

Implication

May warrant closer monitoring in female, African American, and smoking patients on ICIs; hypothesis-generating and requires prospective validation.

Key Points

To evaluate the incidence and identify demographic and clinical risk factors associated with cardiotoxic events in cancer patients treated with immune checkpoint inhibitors.
Retrospectively reviewed electronic health records of N=538 patients receiving durvalumab, ipilimumab, nivolumab, or pembrolizumab at Wake Forest Baptist Health.
Tracked new-onset cardiac endpoints (heart failure, atrial fibrillation, ventricular arrhythmias, myocarditis, pericarditis) and identified predictors using multivariable generalized linear and logistic regression models.
Identified 34 total cardiac events across 538 patients, most commonly pericarditis (n=12, 2.2%), atrial fibrillation with rapid ventricular response (n=11, 2.0%), and heart failure (n=8, 1.5%).
Significant independent risk factors for cardiotoxic events included tobacco use (IRR 4.21, 95% CI 1.289–13.763; P = 0.017), African American race (IRR 3.39, 95% CI 1.141–10.055; P = 0.028), and female sex (IRR 3.34, 95% CI 1.421–7.849; P = 0.006).

Structured PICO

Do specific demographic and cardiovascular risk factors increase the risk of cardiotoxic events in patients treated with immune checkpoint inhibitors?

Population

538 patients who underwent immunotherapy with durvalumab, ipilimumab, nivolumab, or pembrolizumab at a single center (Wake Forest Baptist Health). Mean age ~65-66.

Intervention

Immune checkpoint inhibitors (durvalumab, ipilimumab, nivolumab, pembrolizumab)

Outcome

Composite of incident myocarditis, pericarditis, atrial fibrillation with rapid ventricular response, ventricular fibrillation/tachycardia, heart failure with preserved ejection fraction, and heart failure with reduced ejection fractioncomposite

Limitations

Retrospective design
Intervals between clinical visits/evaluations could not be standardized
Incomplete echocardiogram data
Paucity of troponin and advanced cardiac imaging
Likely missed events due to patients moving out of network or passing away outside the hospital
Additive effect of ICI use not explored

Cite This Study

Brumberger et al. (2022) studied this question.

synapsesocial.com/papers/6a89cdc8abb0ef83c5c99411 https://doi.org/10.1186/s40959-022-00130-5

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Implication

May warrant closer monitoring in female, African American, and smoking patients on ICIs; hypothesis-generating and requires prospective validation.

Cardiotoxicity risk factors with immune checkpoint inhibitors

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Cardiotoxicity risk factors with immune checkpoint inhibitors

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

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