Clinical Features and Outcomes of Immune Checkpoint Inhibitor-Associated Cardiovascular Toxicities

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Title:	Clinical Features and Outcomes of Immune Checkpoint Inhibitor-Associated Cardiovascular Toxicities
Authors:	Wu, Nan-Chun Feng, Yin-Hsun Kuo, Yu Hsuan Chen, Wei-Yu Wu, Hong-Chang Huang, Chien-Tai Wang, Wen-Ching Kang, Nai-Wen Shih, Jhih-Yuan Chen, Zhih-Cherng Chang, Wei-Ting
Contributors:	Chi Mei Hospital Chia Nan University of Pharmacy & Science, Department of Hospital and Health Care Administration Chi Mei Hospital Chi Mei Hospital Chi Mei Hospital Chia Nan University of Pharmacy & Science Southern Taiwan University of Science & Technology National Cheng Kung University
Keywords:	cancer-patients myocarditis mechanisms cardiology management diagnosis therapy
Date:	2022
Issue Date:	2023-12-11 13:55:40 (UTC+8)
Publisher:	TAIWAN SOC CARDIOLOGY
Abstract:	Background: Despite the increasing prevalence of therapies utilizing immune checkpoint inhibitors (ICIs), the associated cardiovascular complications have been poorly reported. Given the fatality of ICI-related complications, especially myocarditis, optimal risk stratification to predict major adverse cardio- and cerebrovascular events (MACCEs) in patients receiving ICIs is mandatory. Methods: We collected clinical data from patients receiving ICIs, and the primary outcomes were MACCEs, including myocarditis, heart failure, and ischemic stroke. Other systemic immune responses relating to ICIs were also recorded. The median follow-up duration was 3 years. Results: Among 580 patients, the incidence of MACCEs was 3.9%. Older patients, male patients, and patients with lung cancer, liver cirrhosis, or diabetes had higher risks of MACCEs. There was no significant difference between the use of PD-1/PD-L1 inhibitors or CTLA inhibitors in terms of developing cardiovascular toxicities. The development of ICI-related MACCEs was associated with worse survival. Notably, after re-review, by specialists, three patients eventually diagnosed with ICI-related myocarditis had not previously been identified. Only one was treated with pulse steroids, and none survived. The most common concomitant extracardiac immune-related adverse events were myositis/dermatitis, endocrine toxicity and hepatitis. Conclusions: Collectively, ICIs may lead to severe cardiovascular toxicities and require more attention. Early identification, proper diagnosis and prompt treatment are pivotal for improving survival.
Relation:	Acta Cardiologica Sinica, v.38, pp.:39-46
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles

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