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. 2025 Jan 8;11(1):2.
doi: 10.1186/s40959-024-00297-z.

Safety and efficacy of immune checkpoint inhibitors in patients with pre-treatment reduced left ventricular function

Maor Tzuberi  1   2 , Rafael Y Brzezinski  1   2 , Nir Flint  1   2 , Moaad Slieman  1   2 , Lior Zornitzki  1   2 , Dana Viskin  1   2 , Anna Rozenfeld Hemed  1   2 , Barliz Waissengrin  3   2 , Renana Barak  3   2 , Inbal Golomb  3   2 , Ido Wolf  3   2 , Netanel Golan  1   2 , Yan Topilsky  1   2 , Shmuel Banai  1   2 , Livia Kapusta  4   2   5 , Michal Laufer-Perl  6   7
Affiliations

Safety and efficacy of immune checkpoint inhibitors in patients with pre-treatment reduced left ventricular function

Maor Tzuberi et al. Cardiooncology. .

Abstract

Aims: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment outcomes. However, the response varies across different populations, and their use may lead to life-threatening cardiovascular (CV) events. While pre-treatment reduced left ventricular ejection fraction (LVEF) is considered a marker for high-risk cardiotoxicity and a contraindication for anthracycline and HER2-targeted therapies, there is limited evidence on the safety and efficacy of ICIs therapy in patients presenting with pre-treatment reduced LVEF. The study aims to evaluate the safety and efficacy of ICIs therapy in patients with pre-treatment reduced LVEF.

Methods: Retrospective single center cohort of patients treated with ICIs therapy, who performed pre-treatment LVEF assessment. The primary endpoint was to evaluate the safety of ICIs among this population, assessed by CV events (composite of myocarditis, acute coronary syndrome, heart failure, and arrhythmias). The secondary endpoint was to evaluate the efficacy of ICIs, assessed by all-cause mortality and progression-free survival (PFS).

Results: The cohort included 307 patients, with 30 (10%) presenting with pre-treatment reduced LVEF, with a mean LVEF of 39 ± 7%. While a significantly higher incidence of CV events was observed in the reduced LVEF group (37% vs. 14%, p = 0.004), following a multivariate Cox regression analysis including baseline CV diseases and risk factors, pre-treatment reduced LVEF did not remain a significant independent predictor (p = 0.358). No significant differences were observed between the groups regarding all-cause mortality and PFS.

Conclusions: Pre-treatment reduced LVEF was not identified as an independent marker for clinical outcomes in patients treated with ICIs therapy.

Keywords: Cardio-oncology; Cardiotoxicity; ICIs; Immune checkpoint inhibitor; Immunotherapy; LVEF.

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Conflict of interest statement

Declarations. Ethical approval: The study was approved by the Tel Aviv Sourasky Medical Center. Helsinki Regulatory Ethics Committee (Identifier: TLV-0228-16). Consent of publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative Incidence of CV events. Kaplan-Meier Curves Comparing CV events Cumulative Incidence between the two study groups, showing a higher incidence of CV events in the Reduced LVEF group
Fig. 2
Fig. 2
Overall Survival. Kaplan-Meier curves show no statistically significant difference in overall survival. between the Reduced and Preserved LVEF groups. OS = Overall survival
Fig. 3
Fig. 3
Progression-Free Survival. Kaplan-Meier curves depict no statistically significant difference in PFS between the two groups. PFS = progression-free survival
See this image and copyright information in PMC

References

    1. Wolchok JD. PD-1 blockers. Cell. 2015;162(5):937. 10.1016/j.cell.2015.07.045. - PubMed
    1. Provencio M, Nadal E, Insa A, García-Campelo MR, Casal-Rubio J, Dómine M, et al. Neoadjuvant chemotherapy and nivolumab in resectable non-small-cell lung cancer (NADIM): an open-label, multicentre, single-arm, phase 2 trial. Lancet Oncol. 2020;21(11):1413–22. 10.1016/S1470-2045(20)30453-8. - PubMed
    1. Cascone T, William WN, Weissferdt A, Leung CH, Lin HY, Pataer A, et al. Neoadjuvant nivolumab or nivolumab plus ipilimumab in operable non-small cell lung cancer: the phase 2 randomized NEOSTAR trial. Nat Med. 2021;27(3):504–14. 10.1038/s41591-020-01224-2. - PMC - PubMed
    1. Felip E, Altorki N, Zhou C, Csőszi T, Vynnychenko I, Goloborodko O, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial. Lancet. 2021;398(10308):1344–57. 10.1016/S0140-6736(21)02098-5. - PubMed
    1. Rothlin CV, Ghosh S. Lifting the innate immune barriers to antitumor immunity. J Immunother Cancer. 2020;8(1). 10.1136/jitc-2020-000695. - PMC - PubMed

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