Pre-existing diabetes, dyslipidaemia, atrial fibrillation, and prior cardiotoxic treatment independently predicted cardiovascular toxicity in 125 cancer patients on immune checkpoint inhibitors.
What are the independent risk factors for developing immune-related cardiovascular adverse events in cancer patients receiving immune checkpoint inhibitors?
Pre-existing diabetes, dyslipidemia, atrial fibrillation, and prior cardiotoxic treatment are independent predictors of immune-related cardiovascular adverse events in cancer patients receiving immune checkpoint inhibitors.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Immune checkpoint inhibitors (ICIs), including PD-1/PD-L1 and CTLA-4 inhibitors, have significantly improved cancer treatment outcomes. Over the past decade, these therapies have demonstrated remarkable efficacy; however, their use is associated with immune-related cardiovascular adverse events (irCVEs), ranging from mild biomarker alterations to severe conditions such as arrhythmias, myocarditis, pericarditis, left ventricular dysfunction, heart failure, and acute coronary syndrome. Moreover, specific risk factors for irCVEs development remain unknown. Purpose This study aims to identify risk factors for irCVEs in cancer patients receiving ICI. Methods A total of 125 patients undergoing immunotherapy were assessed. From July 2022, each patient underwent baseline and on-treatment evaluations, including physical examination, electrocardiography, echocardiography, and measurement of high-sensitivity troponin I and NT-proBNP. Data were collected from medical records and diagnostic assessments. Logistic regression analysis was performed to identify independent risk factors, excluding imbalanced variables. Initial analysis using the Generalised Linear Model (GLM) in R found no significant predictors, leading to the application of a regularised GLM to enhance prediction accuracy and prevent overfitting. The dataset was divided into a training set (87 patients) and a test set (38 patients). Model optimisation involved hyperparameter tuning (penalty: 0.0000000001, mixture: 0), with validation based on key performance metrics (accuracy: 68%, precision: 83%, sensitivity: 77%, specificity: 29%, F-measure: 0.80, Cohen’s Kappa: 0.05). Results Our study identified 17 events, including 6 cases of asymptomatic cardiac biomarker elevation, 3 cases of myocarditis, 1 case of pericarditis, 3 cases of heart failure, 1 case of atrial fibrillation, and 3 cases of acute coronary syndrome, most of which occurred after the first ICI administration. Pre-existing diabetes, dyslipidaemia, atrial fibrillation, and prior treatment with a potentially cardiotoxic regimen emerged as independent predictors of irCVEs development. Additionally, our evaluation proved to be a reliable predictor of irCVEs development in medium- and high-risk patients according to ESC Guidelines 2022. No irCVEs-related deaths were reported. Conclusion Immunotherapy represents a major advancement in cancer care, yet early identification and risk stratification of irCVEs are crucial to minimising complications and optimising patient outcomes. Our findings underscore the need for proactive strategies to improve early irCVEs detection and risk assessment. This study provides real-world insights into irCVEs; however, our findings should be interpreted cautiously due to the limited sample size and low event incidence. Further ongoing research aims to expand patient cohorts and refine predictive models to support standardised prevention strategies.
Marco et al. (Sat,) reported a other. Pre-existing diabetes, dyslipidaemia, atrial fibrillation, and prior cardiotoxic treatment independently predicted cardiovascular toxicity in 125 cancer patients on immune checkpoint inhibitors.