Key result
Immune checkpoint inhibitor treatment was not significantly associated with an increased risk of major adverse cardiovascular events compared to non-ICI systemic therapy (HR 1.12, 95% CI 0.56-2.22).
Why the study?
Conflicting information exists regarding whether immune checkpoint inhibitor treatment increases the risk for major adverse cardiovascular events in cancer patients.
Does immune checkpoint inhibitor treatment increase the risk of major adverse cardiovascular events in patients with solid cancers?
Cohort (n=321)
No
Does immune checkpoint inhibitor treatment increase the risk of major adverse cardiovascular events in patients with solid cancers?
Hazard Ratio: 1.12 (95% CI 0.56–2.22)
Absolute Event Rate: 14% vs 9.3%
In patients with solid cancers, immune checkpoint inhibitor treatment was not significantly associated with an increased risk of MACE after adjusting for comorbidities, highlighting the importance of baseline cardiovascular risk in this population.
BACKGROUND: Cancer patients have an increased risk for cardiovascular diseases (CVDs). Conflicting information exists regarding whether cancer treatment with immune checkpoint inhibitors (ICIs) itself increases the risk for CVDs. We therefore assessed the incidence of major adverse cardiovascular events (MACE) in cancer patients treated with versus without ICIs. METHODS: One hundred fifty-eight and 163 cancer patients, treated with and without ICIs respectively, were compared. The primary endpoint was the incidence of MACE, defined as acute coronary syndrome, ischemic stroke, transient ischemic attack, new or worsening coronary artery disease or peripheral arterial occlusive disease, or cardiovascular death. We used Cox proportional hazard models and competing risk models (death), adjusted for age, sex and comorbidities (Charlson Comorbidity index, CCI) to investigate the cause-specific association between ICI-treatment and MACE. RESULTS: Over a median follow-up of 30.6 months, 37 MACE occurred. The overall incidence of MACE was 14.0% in patients with and 9.3% in patients without ICI-treatment. In the multivariate analysis CCI was significantly associated with MACE (HR 1.19, 95% CI [1.03, 1.37]), whereas no association was found for ICI-treatment (HR 1.12, 95% CI [0.56, 2.22]). Competing risk analysis showed no treatment associations. CCI was associated with non-cardiovascular mortality. CONCLUSIONS: We did not observe statistical evidence of an association between ICI treatment and MACE. There is evidence that a higher comorbidity burden is associated with MACE. Comorbidities are clearly associated with non-cardiovascular mortality in cancer patients. Further prospective studies are required to investigate whether treating comorbidities and optimizing cardiovascular risk factors result in improved outcomes among cancer patients.
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Daetwyler et al. (2026) conducted a cohort in Solid cancer (n=321). Immune checkpoint inhibitors (ICIs) vs. Systemic anti-cancer treatment without ICIs was evaluated on Incidence of major adverse cardiovascular events (MACE), defined as acute coronary syndrome, ischemic stroke, transient ischemic attack, new or worsening coronary artery disease or peripheral arterial occlusive disease, or cardiovascular death (HR 1.12, 95% CI 0.56-2.22). Immune checkpoint inhibitor treatment was not significantly associated with an increased risk of major adverse cardiovascular events compared to non-ICI systemic therapy (HR 1.12, 95% CI 0.56-2.22).
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