Key result
Immune-related adverse events during ICI therapy are not linked to higher rates of elevated hs-cTnI.
Why the study?
There are no biomarkers to predict immune-related adverse events during immune checkpoint inhibitor therapy, and the role of cardiac troponin I in this context is unclear.
Case-Control (n=45)
Absolute Event Rate: 19% vs 25%
OBJECTIVES: Immune checkpoint inhibitors (ICIs) cause a variety of toxicities, including immune-related adverse events (irAEs), but there are no biomarkers to predict their development. Guidelines recommend measuring circulating cardiac troponin I (cTnI) during ICI therapy to detect related cardiotoxicities. Moreover, elevated cTnI has also been associated with worse outcomes in non-cardiac patients, including cancer. Thus here, we investigated whether cTnI levels were higher in patients with irAEs. METHODS: The study consisted of three groups; 21 cancer patients undergoing ICI immunotherapies who presented with irAEs, four patients without irAEs, and 20 healthy controls. Patient samples were assessed at baseline (n=25), during ICI treatment (n=25, median=6 weeks of treatment) and at toxicity (n=6, median=13 weeks of treatment). In addition to blood high sensitivity cardiac troponin I (hs-cTnI), anti-thyroglobulin (TG) and anti-thyroid peroxidase (TPO) antibodies were also quantitated to detect thyroid dysfunction, constituting the second leading toxicity (23.8%) after pneumonitis (28.6%). RESULTS: Four patients with irAEs (n=4/21; 19%) and one without irAEs (n=1/4; 25%) showed higher hs-cTnI levels at any time-point; the remaining had physiological levels. None of these patients developed cardiotoxicity. Concurrent elevated levels of anti-thyroid antibodies and hs-cTnI were detected in one patient with thyroid dysfunction (n=1/5, 20%). However, these antibodies were also elevated in three patients (n=3/16, 19%) with non-thyroid irAEs and in up to 40% of healthy controls. CONCLUSIONS: hs-cTnI was not elevated in patients with irAEs, but larger studies are needed to confirm these observations.
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Ulndreaj et al. (2022) conducted a case-control in Cancer patients treated with immune checkpoint inhibitors (n=45). Immune-related adverse events (irAEs) during ICI therapy vs. Patients without irAEs and healthy controls was evaluated on Elevated high sensitivity cardiac troponin I (hs-cTnI) levels. Elevated hs-cTnI levels were observed in 19% of cancer patients with immune-related adverse events on ICI therapy compared to 25% of those without irAEs.
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