Patients experiencing extracardiac immune-related adverse events during immune checkpoint inhibitor therapy had a twofold higher risk of developing cancer-therapy related cardiac dysfunction (RR 2.05).
Cohort (n=266)
No
Does the occurrence of extracardiac immune-related adverse events (eirAEs) increase the risk of cancer-therapy related cardiac dysfunction (CTRCD) in cancer patients undergoing immune checkpoint inhibitor therapy?
Intensified serial echocardiographic surveillance reveals a high incidence of cancer-therapy related cardiac dysfunction (35.7%) in patients on immune checkpoint inhibitors, particularly those who develop extracardiac immune-related adverse events.
Relative Risk: 2.05 (95% CI 1.49–2.83)
Absolute Event Rate: 51.92% vs 25.3%
p-value: p=<0.001
Abstract Background and aims With the increasing approval of immune checkpoint inhibitors (ICI) for cancer treatment, there is a rising incidence of potentially life-threatening cancer-therapy related cardiac dysfunction (CTRCD). Current 2022 European Society of Cardiology (ESC) guidelines on cardio-oncology recommend a single baseline transthoracic echocardiogram (TTE) for high-risk ICI-treated patients, potentially underestimating the incidence of CTRCD due to lack of follow-up assessments. This study aims to characterize the incidence of CTRCD in cancer patients undergoing ICI therapy using an intensified TTE surveillance approach and to investigate whether extracardiac immune-related adverse events (eirAEs) are associated with CTRCD. Methods We analysed patients scheduled for ICI therapy from the Essen Cardio-Oncology Registry (EcoR). Data were collected during cardio-oncology consultations at baseline, 6 weeks, 6 months, and 12 months. Patients with eirAEs were evaluated compared to patients without eirAEs. Results Among 2,540 cancer patients registered in EcoR until march 2023, 266 (61 ± 14 years, 40.6% female, 86.5% melanoma, 62% metastatic disease) were scheduled for ICI therapy. CTRCD was observed in 35.7% of patients, with 32.7% having asymptomatic mild CTRCD, 0.37% moderate CTRCD, and 2.63% developing heart failure with preserved ejection fraction (HFpEF). Patients with eirAEs had a twofold higher risk of CTRCD (relative risk RR 2.05, 95% CI: 1.49–2.83, p < 0.001) and a 66% increased risk of cardiovascular toxicity (RR 1.66, 95% CI 1.30–2.13, p < 0.001). Conclusions ICI therapy is associated with a high prevalence of CTRCD, underscoring the importance of serial echocardiography evaluation, particularly for patients with eirAEs. Enhanced cardio-oncology surveillance is crucial for improving patient outcomes and survival.
Mincu et al. (Tue,) conducted a cohort in Cancer patients scheduled for immune checkpoint inhibitor therapy (n=266). Extracardiac immune-related adverse events (eirAEs) vs. No extracardiac immune-related adverse events was evaluated on Incidence of cancer-therapy related cardiac dysfunction (CTRCD) (RR 2.05, 95% CI 1.49-2.83, p=<0.001). Patients experiencing extracardiac immune-related adverse events during immune checkpoint inhibitor therapy had a twofold higher risk of developing cancer-therapy related cardiac dysfunction (RR 2.05).