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. 2020 Nov 26;12(11):584-598.
doi: 10.4330/wjc.v12.i11.584.

Cardiac adverse events of immune checkpoint inhibitors in oncology patients: A systematic review and meta-analysis

Nso Nso  1 , Daniel Antwi-Amoabeng  2 , Bryce D Beutler  3 , Mark B Ulanja  2 , Jasmine Ghuman  2 , Ahmed Hanfy  2 , Joyce Nimo-Boampong  4 , Sirri Atanga  5 , Rajkumar Doshi  2 , Sostanie Enoru  6 , Nageshwara Gullapalli  2
Affiliations

Cardiac adverse events of immune checkpoint inhibitors in oncology patients: A systematic review and meta-analysis

Nso Nso et al. World J Cardiol. .

Abstract

Background: Immune checkpoint inhibitors (ICIs) are novel therapeutic agents used for various types of cancer. ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients. However, immune-related adverse effects of ICI therapy are common. Cardiovascular immune-related adverse events (irAEs) are rare but potentially life-threatening complications.

Aim: To estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies.

Methods: We conducted this systematic review and meta-analysis by searching PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs. We performed a single-arm meta-analysis using OpenMeta [Analyst] software of the following outcomes: Myocarditis, pericardial effusion, heart failure, cardiomyopathy, atrial fibrillation, myocardial infarction, and cardiac arrest. We assessed the heterogeneity using the I2 test and managed to solve it with Cochrane's leave-one-out method. The risk of bias was performed with the Cochrane's risk of bias tool.

Results: A total of 26 studies were included. The incidence of irAEs follows: Myocarditis: 0.5% [95% confidence interval (CI): 0.1%-0.9%]; Pericardial effusion: 0.5% (95%CI: 0.1%-1.0%); Heart failure: 0.3% (95%CI: 0.0%-0.5%); Cardiomyopathy: 0.3% (95%CI: -0.1%-0.6%); atrial fibrillation: 4.6% (95%CI: 1.0%-14.1%); Myocardial infarction: 0.4% (95%CI: 0.0%-0.7%); and Cardiac arrest: 0.4% (95%CI: 0.1%-0.8%).

Conclusion: The most common cardiovascular irAEs were atrial fibrillation, myocarditis, and pericardial effusion. Although rare, data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICI-associated cardiovascular complications.

Keywords: Atrial fibrillation; Cancer; Cardiovascular adverse events; Immune checkpoint inhibitors; Immunotherapy; Pericardial effusion.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no actual or potential conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA diagram for our literature search.
Figure 2
Figure 2
Results of risk of bias assessment among included trials.
Figure 3
Figure 3
Incidence of myocarditis. CI: Confidence interval.
Figure 4
Figure 4
Incidence of pericardial effusion. CI: Confidence interval.
Figure 5
Figure 5
Incidence of heart failure. CI: Confidence interval.
Figure 6
Figure 6
Incidence of cardiomyopathy. CI: Confidence interval.
Figure 7
Figure 7
Incidence of atrial fibrillation. A: Incidence of atrial fibrillation with heterogeneity; B: Incidence of atrial fibrillation after correction with Cochrane’s leave-one-out method. CI: Confidence interval.
Figure 8
Figure 8
Incidence of myocardial infarction. CI: Confidence interval.
Figure 9
Figure 9
Incidence of cardiac arrest. CI: Confidence interval.
See this image and copyright information in PMC

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