Evaluating the clinical utility and impact on healthcare utilization of serial troponin T monitoring in gynecologic cancer patients receiving immune checkpoint inhibitors – A single centre experience

OBJECTIVES: The primary objective of this study was to report on the clinical utility of serial troponin T (cTnT) monitoring in patients with gynecological cancers receiving immune checkpoint inhibitors (ICIs). Secondary objectives were to describe the experience of a single centre within a public healthcare system and to discuss the associated increase in healthcare utilization resulting from this intense monitoring strategy. METHODS: We conducted a retrospective cohort study of all patients with endometrial, cervical, and vaginal cancers treated with ICIs at Sunnybrook Health Sciences Centre, Toronto, Canada, until June 2024. Serial cTnT was measured at baseline and prior to each cycle. Comprehensive clinical data was collected. Associations between cTnT elevation and outcomes were analyzed. RESULTS: Sixty-eight patients were included: 41 (60.3 %) with endometrial, 25 (36.8 %) with cervical, and 2 (2.9 %) with vaginal cancer. At baseline, 37.9 % had elevated cTnT. During therapy, 63.2 % experienced at least one troponin elevation above the upper normal limit. Troponin increases were associated with age, hypertension, and other immune-related adverse events, but not with overall survival. Two patients (2.9 %) developed confirmed ICI-induced myocarditis. In total, over 1400 cTnT assays were performed, leading to multiple downstream investigations and treatment delays without consistent clinical benefit. CONCLUSIONS: Serial cTnT monitoring frequently identified biomarker elevations but was not associated with outcomes in gynecologic cancer patients receiving ICIs. Despite a 63.2 % rate of elevated troponin, ICI-induced myocarditis occurred in 2.9 %. These findings suggest the need for evidence-based guidelines that balance early toxicity detection with safety, treatment continuity, and resource stewardship.