Key result
Prior diabetes links to ~93% higher cardiotoxicity risk alongside smoking and CVD in NSCLC TKI/ICI patients.
Why the study?
Cardiotoxicity is a common and under-reported side effect of TKIs and ICIs, and baseline risk factors may help in risk-stratifying patients with NSCLC at increased risk.
Do baseline risk factors (diabetes, smoking, previous cardiovascular disease) predict cardiotoxicity in NSCLC patients treated with TKIs and/or ICIs?
Cohort (n=451)
No
Do baseline risk factors (diabetes, smoking, previous cardiovascular disease) predict cardiotoxicity in NSCLC patients treated with TKIs and/or ICIs?
Odds Ratio: 1.93 (95% CI 1.04–3.61)
p-value: p=0.038
Baseline diabetes, smoking, and cardiovascular disease are significant predictors of cardiotoxicity in NSCLC patients treated with TKIs or ICIs, highlighting the need for baseline risk stratification in cardio-oncology.
Purpose Cardiotoxicity is a common and under-reported side effect of tyrosine-kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI). Baseline risk factors may help in risk-stratifying patients at increased risk of cardiotoxicity. This real-world study investigated the effects of baseline risk factors in cardiotoxicity on patients with non-small cell lung cancer (NSCLC) treated with TKIs and ICIs. Methods This is a retrospective study carried out at The Royal Marsden Hospital, UK. Newly diagnosed patients with localised or metastatic NSCLC who received anti-cancer therapy with TKIs and/or ICIs were eligible. Patients who received only chemotherapy were excluded. Patients were followed up from the time of diagnosis until death or discharge. The relationship between cardiotoxicity and risk factors were tested by logistic regression. Results 88/451 (19.5%) patients developed cardiotoxicity. Risk factors hypothesised to have a causal relationship with anti-cancer treatment-induced cardiotoxicity were analysed. Cardiotoxicity risk was increased with prior diabetes mellitus (OR=1.93, 95% CI, 1.04 to 3.61, P =0.038), history of smoking (OR=1.91, 95% CI, 1.13 to 3.22, P =0.016) and presence of baseline cardiovascular disease (OR=2.03, 95% CI, 1.13 to 3.64, P =0.018). The risk of developing cardiotoxicity increased in patients for smokers with diabetes mellitus (OR=3.03, 95% CI, 1.40 to 6.55, P <0.01) and for smokers with previous cardiovascular disease (OR=1.99, 95% CI, 1.03 to 3.84, P =0.041). Conclusion Diabetes mellitus, smoking and baseline cardiovascular disease may synergistically contribute to cardiotoxicity when a patient is exposed to potentially cardiotoxic anti-cancer agents. Risk stratification at baseline may improve cardio-oncology care. Micro abstract Cardiotoxicity is an undesirable side effect of cancer drugs used in the treatment of lung cancer. The relationship between risk factors and cardiotoxicity was tested on 451 patients. Diabetes, smoking, and pre-existing cardiovascular disease may have a combined effect on increasing the risk of heart damage in lung cancer patients. Risk stratification at baseline may improve cardio-oncology care.
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Kobat et al. (2023) conducted a cohort in Non-small cell lung cancer (NSCLC) (n=451). Prior diabetes mellitus, smoking, and baseline cardiovascular disease vs. Absence of these risk factors was evaluated on Cardiotoxicity (OR 1.93, 95% CI 1.04-3.61, p=0.038). Prior diabetes mellitus (OR 1.93; 95% CI 1.04-3.61), smoking, and baseline cardiovascular disease significantly increased the risk of cardiotoxicity in NSCLC patients treated with TKIs and ICIs.
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