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. 2022 Dec 1:9:1062858.
doi: 10.3389/fcvm.2022.1062858. eCollection 2022.

Assessing the risk of cardiovascular events in patients receiving immune checkpoint inhibitors

María Torrente  1   2 , Mariola Blanco  1 , Fabio Franco  1 , Yago Garitaonaindia  1 , Virginia Calvo  1 , Ana Collazo-Lorduy  1 , Lourdes Gutiérrez  1 , Juan Cristóbal Sánchez  1 , Aranzazu González-Del-Alba  1 , Roberto Hernández  1 , Miriam Méndez  1 , Blanca Cantos  1 , Beatriz Núñez  1 , Pedro A C Sousa  3 , Mariano Provencio  1
Affiliations

Assessing the risk of cardiovascular events in patients receiving immune checkpoint inhibitors

María Torrente et al. Front Cardiovasc Med. .

Abstract

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. However, despite their excellent therapeutic effect, these medications typically result in a broad spectrum of toxicity reactions. Immune-related cardiotoxicity is uncommon but can be potentially fatal, and its true incidence is underestimated in clinical trials. The aim of this study is to assess the incidence and identify risk factors for developing a cardiac event in patients treated with ICIs.

Methods: We conducted a single-institution retrospective study, including patients treated with ICIs in our center. The main outcomes were cardiac events (CE) and cardiovascular death.

Results: A total of 378 patients were analyzed. The incidence of CE was 16.7%, during a median follow-up of 50.5 months. The multivariable analysis showed that age, a history of arrhythmia or ischemic heart disease, and prior immune-related adverse events were significantly associated with CE.

Conclusion: CE during ICI treatment are more common than currently appreciated. A complete initial cardiovascular evaluation is recommended, especially in high-risk patients, being necessary a multidisciplinary approach of a specialized cardio-oncology team.

Keywords: cardiotoxicity; cardiovascular event; immune checkpoint inhibitors; myocarditis; risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Cumulative Incidence Function (CIF) of cardiac events.
FIGURE 2
FIGURE 2
Predictive risk score for developing a cardiac event during ICI treatment.
See this image and copyright information in PMC

References

    1. Zhou YW, Zhu YJ, Wang MN, Xie Y, Chen CY, Zhang T, et al. Immune checkpoint inhibitor-associated cardiotoxicity: current understanding on its mechanism, diagnosis and management. Front Pharmacol. (2019) 10:1350. 10.3389/fphar.2019.01350 - DOI - PMC - PubMed
    1. Swaika A, Hammond WA, Joseph RW. Current state of anti-PD-L1 and anti-PD-1 agents in cancer therapy. Mol Immunol. (2015) 67(2 Pt A):4–17. - PubMed
    1. Walker LS, Sansom DM. The emerging role of CTLA4 as a cell-extrinsic regulator of T cell responses. Nat Rev Immunol. (2011) 11:852–63. 10.1038/nri3108 - DOI - PubMed
    1. Boussiotis VA. Molecular and biochemical aspects of the PD-1 checkpoint pathway. N Engl J Med. (2016) 375:1767–78. 10.1056/NEJMra1514296 - DOI - PMC - PubMed
    1. Hino R, Kabashima K, Kato Y, Yagi H, Nakamura M, Honjo T, et al. Tumor cell expression of programmed cell death-1 ligand 1 is a prognostic factor for malignant melanoma. Cancer. (2010) 116:1757–66. - PubMed

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