Key result
Incident CVD after immune checkpoint inhibitors is linked to ~177% higher mortality.
Why the study?
Immune checkpoint inhibitors are associated with immune-related adverse events including cardiotoxicity, but the incidence of newly diagnosed cardiovascular disease in clinical practice needed estimation.
What is the incidence of newly diagnosed cardiovascular disease in cancer patients treated with immune checkpoint inhibitors in a real-world setting?
Cohort (n=424)
No
What is the incidence of newly diagnosed cardiovascular disease in cancer patients treated with immune checkpoint inhibitors in a real-world setting?
In a real-world cohort, nearly 15% of patients treated with immune checkpoint inhibitors developed newly diagnosed cardiovascular disease, which was associated with a nearly three-fold increase in mortality.
Supports closer CVD monitoring in ICI-treated patients; hypothesis-generating for prospective incidence and risk-stratification studies.
BACKGROUND: Immune checkpoint inhibitors (ICIs) are a novel class of anticancer agents that have demonstrated clinical response for both solid and hematological malignancies. ICIs are associated with development of immune-related adverse events including cardiotoxicity. We estimated the incidence of newly diagnosed cardiovascular disease in patients treated with ICIs at a large, tertiary care center. METHODS: All patients with a cancer diagnosis who received any ICI treatment in the University of Florida's Integrated Data Repository from 2011 to 2017 were included. Cardiovascular disease was defined as a new ICD diagnosis code for cardiomyopathy, heart failure, arrhythmia, heart block, pericardial disease, or myocarditis after initiation of ICI treatment. RESULTS: Of 102,701 patients with a diagnosis of malignancy, 424 patients received at least one ICI. Sixty-two (14.6%) patients were diagnosed with at least one new cardiovascular disease after initiation of ICI therapy. Of the 374 patients receiving one ICI, 21 (5.6%) developed heart failure. Of the 49 patients who received two ICIs sequentially, three (6.1%) developed heart failure and/or cardiomyopathy. Incident cardiovascular disease was diagnosed at a median of 63 days after initial ICI exposure. One patient developed myocarditis 28 days after receiving nivolumab. Mortality in ICI treated patients with a concomitant diagnosis of incident cardiovascular disease was higher compared to those who did not (66.1% vs. 41.4%, odds ratio = 2.77, 1.55-4.95, p = 0.0006). CONCLUSIONS: This study suggests a high incidence of newly diagnosed cardiovascular disease after the initiation of ICI therapy in a real-world clinical setting.
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Waheed et al. (2021) conducted a cohort in Malignancy treated with immune checkpoint inhibitors (n=424). Immune checkpoint inhibitors was evaluated on Incidence of newly diagnosed cardiovascular disease (95% CI 11.3-18.0). In patients treated with immune checkpoint inhibitors, 14.6% developed newly diagnosed cardiovascular disease, which was associated with significantly higher mortality (OR 2.77) compared to those without incident cardiovascular disease.
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