Abstract 13014: Gender Differences in the Incidence of Adverse Cardiovascular Events in Cancer Patients Treated With Immune Checkpoint Inhibitors

Abstract

Introduction: Immune checkpoint inhibitors (ICIs) are increasingly being used for cancer therapy. Cardiotoxicity from ICIs has largely been underestimated since cardiovascular monitoring is not routinely performed after initiating immunotherapy. Cardiotoxic side effects are uncommon but are serious complications of ICIs with a high morbidity and mortality. Hypothesis: Adverse cardiovascular events in cancer patients are associated with the number of immune checkpoint inhibitor injections and the gender. Methods: In this observational, retrospective, pharmacovigilance study, we used MarketScan Databases to compare cardiovascular adverse events reported in patients who received ICIs. The data used in this study was fully integrated and de-identified data. The study included 9,583 male and 6,991 female patients who had cancer and underwent ICI therapy between Jan 1, 2011 and Dec 31, 2018. ICI drugs in this study included nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and ipilimumab. The time to an event and the end of follow-up was counted from the time of first ICI injection. Our primary exposure variable was gender. Results: At least one cardiovascular IRAE was reported in 3,804 (23%) of 16,574 patients enrolled in the study. The hazard time to cardiovascular events (CVEs) between the male and female gender varied by age. There was no difference in CVEs between males and females at a younger age. The hazard time to CVEs increased with age above 60 years in males when compared to females. The hazard of time to CVE in males was 1.18 times the hazard in females at the mean study age of 60.5 years. Adjusted Kaplan-Meier survival curves for males and females stratified by ICI injection categories showed that those with fewer number of ICI injections had a shorter time to CVE. Conclusions: The number of ICI injections and the gender both impact adverse cardiovascular events in cancer patients. Managing and reducing cardiotoxicity is vital for safe delivery of this effective therapy. There needs to be multidisciplinary approach between primary care physicians, cardiologists, oncologists, and immunologists for better understanding and management of ICI associated cardiotoxicity.