Abstract 12005: Increased Risk of Cancer Therapy-Related Cardiomyopathy in Patients With Treated Immune Checkpoint Inhibitors and Concomitant Cardiotoxic Agents

Abstract

Introduction: There is scarce data on whether immune checkpoint inhibitor (ICI) increase the risk of cardiomyopathy, especially when used with cardiotoxic agents. Hypothesis: We evaluated the cardiotoxicity of the ICI in sarcoma patients receiving doxorubicin with or without ICI by echocardiographic parameters and left ventricular global longitudinal strain (LVGLS). Methods: A total of 89 patients were included. Echocardiography and LVGLS were evaluated at baseline and follow-up (after 3 and 6months) and compared between the doxorubicin (n=67) and concomitant ICI with doxorubicin (n=22) groups. Cancer-therapy related cardiac dysfunction (CTRCD) was defined as LVEF drop of >10% and LVEF of <50% (definite CTRCD) and LVEF drop of >10%, LVEF of > 50% and LVGLS relative reduction of >15% (probable CTRCD) at 6months. Results: There was no significant difference in age, cumulative dose of doxorubicin and cardiovascular risk factors between two groups. At baseline, LVEF was similar between two groups (p=0.493). In doxorubicin group, LVEF decreased to 59±6 % (p<0.001) and LVGLS decreased from -16.5±3.2 to -14.6±3.2 % (p<0.001) at 6-month. In concomitant ICI and doxorubicin group, LVEF decreased to 55±9 % (p<0.001), along with significantly decreasing LVGLS (-18.6±1.9 to -15.3±3.6 %, p<0.001). Over a median follow-up of 192 days, there were no cases with clinical manifestation of myocarditis. In doxorubicin group, definite and probable CTRCD were 7 (10.1%) and 5 (7.4%) patients, respectively. In concomitant ICI and doxorubicin group, definite and probable CTRCD were 4 (19%) and 4 (19%) patients, respectively. Total CTRCD occurred significantly more in concomitant ICI and doxorubicin than doxorubicin group (38.1% vs. 17.4%, p=0.042). Conclusions: ICI increases risk of CTRCD, when concomitantly treated with cardiotoxic agents. Thus, cardiomyopathy should be monitored in patients with ICI by comprehensive echocardiographic assessment including myocardial strain.