Key result
Routine troponin I monitoring in ICI patients is linked to ~83% fewer severe CV adverse events.
Why the study?
Immune checkpoint inhibitors are associated with cardiac immune-related adverse events including fulminant myocarditis, and the impact of routine troponin I-based cardiotoxicity screening on clinical outcomes is unclear.
Does routine cardiotoxicity screening with serial troponin I monitoring reduce cardiovascular adverse events and improve overall survival in asymptomatic patients receiving immune checkpoint inhibitors?
Cohort (n=825)
No
Does routine cardiotoxicity screening with serial troponin I monitoring reduce cardiovascular adverse events and improve overall survival in asymptomatic patients receiving immune checkpoint inhibitors?
Hazard Ratio: 0.17 (95% CI 0.02–0.79)
Absolute Event Rate: 0.5% vs 1.8%
p-value: p=0.04
Routine serial troponin I monitoring in patients receiving immune checkpoint inhibitors may facilitate early detection and reduce the incidence of severe cardiovascular adverse events.
May support troponin monitoring in ICI recipients; leaves open need for randomized confirmation before practice change.
Purpose: Immune checkpoint inhibitors (ICI) used as cancer therapy have been associated with a range of cardiac immune-related adverse events (irAEs), including fulminant myocarditis with a high case fatality rate. Early detection through cardiotoxicity screening by biomarker monitoring can lead to prompt intervention and improved patient outcomes. In this study, we investigate the association between cardiotoxicity screening with routine serial troponin I monitoring in asymptomatic patients receiving ICI, cardiovascular adverse event (CV AE) detection, and overall survival (OS). Methods: We instituted a standardized troponin I screening protocol at baseline and with each ICI dose (every 2-4 weeks) in all patients receiving ICI at our center starting Jan 2019. We subsequently collected data in 825 patients receiving ICI at our institution from January 2018 to October 2021. Of these patients, 428 underwent cardiotoxicity screening with serial troponin I monitoring during ICI administration (Jan 2019-Oct 2021) and 397 patients were unmonitored (Jan 2018-Dec 2018). We followed patients for nine months following their first dose of ICI and compared outcomes of CV AEs and OS between monitored and unmonitored patients. Additionally, we investigated rates of CV AEs, all-cause mortality, and oncologic time-to-treatment failure (TTF) between patients with an elevated troponin I value during the monitoring period versus patients without elevated troponin I. Results: We found a lower rate of severe (grades 4-5) CV AEs, resulting in critical illness or death, in patients who underwent troponin monitoring (0.5%) compared to patients who did not undergo monitoring (1.8%), (HR 0.17, 95% CI 0.02-0.79, p = 0.04). There was no difference in overall CV AEs (grades 3-5) or OS between monitored and unmonitored patients. In the entire cohort, patients with at least one elevated troponin I during the follow up period, during routine monitoring or unmonitored, had a higher risk of overall CV AEs (HR 10.96, 95% CI 4.65-25.85, p<0.001) as well as overall mortality (HR 2.67, 95% CI 1.69 - 4.10, p<0.001) compared to those without elevated troponin. Oncologic time-to-treatment failure (TTF) was not significantly different in a sub-cohort of monitored vs. unmonitored patients. Conclusions: Patients undergoing cardiotoxicity screening with troponin I monitoring during ICI therapy had a lower rate of severe (grade 4-5) CV AEs compared patients who were not screened. Troponin I elevation in screened and unscreened patients was significantly associated with increased CV AEs as well as increased mortality. Troponin I monitoring did not impact oncologic time-to-treatment-failure in a sub-cohort analysis of patients treated with ICI. These results provide preliminary evidence for clinical utility of cardiotoxicity screening with troponin I monitoring in patients receiving ICI therapy.
No takes yet. Share an insight, caveat, or question.
Ivanovic et al. (2024) conducted a cohort in Cancer patients receiving immune checkpoint inhibitors (n=825). Routine serial troponin I monitoring vs. Unmonitored patients was evaluated on Severe (grade 4-5) cardiovascular adverse events (HR 0.17, 95% CI 0.02-0.79, p=0.04). Routine troponin I monitoring in patients receiving immune checkpoint inhibitors was associated with a significantly lower rate of severe cardiovascular adverse events compared to no monitoring (HR 0.17).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: