Abstract 17029: Risk Stratification and Real World Incidence of Cardiac Toxicity With Immune Checkpoint Inhibitors

Abstract

Introduction: Awareness of cardiac toxicity with immune checkpoint inhibitor (ICI) therapy is increasing with emerging data on the manifestations and diagnosis of cardiotoxicity. However, risk stratification of these patients remains undefined. Hypothesis: We examined associations of traditional cardiovascular risk factors with ICI cardiotoxicity and patterns of cardiac evaluation prior to and during ICI therapy within a quaternary integrated health network. Methods: We reviewed patients on ICIs for atherosclerotic cardiovascular disease (ASCVD) risk factors, cardiology office visits, patterns of screening for cardiac disease (ECG, echocardiogram, cardiac biomarkers), and correlated with the incident of cardiac adverse events. Results: We studied 344 patients receiving ICIs for lung cancer (50%), melanoma (15%), and other malignancies (34%). Smoking (75%), hypertension (71%), and hyperlipidemia (49%) were the most common ASCVD risk factors. Pre-ICI initiation cardiac evaluation included ECG in 60%, TTE in 37%, and 63% of patients had at least one ECG or TTE while on ICIs. Less than 20% were seen by Cardiology before ICI therapy, despite 81% having ≥2 ASCVD risk factors. Cardiac toxicity with ICIs was observed in 12% of patients and was significantly more common in those with more ASCVD risk factors (4.6% vs 9.7% vs 16.4% with 0-1 vs 2-3 vs ≥4 ASCVD risk factors, respectively; P= 0.03) and in patients with atrial fibrillation (AFib) before ICI initiation (26.5% vs 8.5% without AFib; P=0.0008). ICIs were discontinued in 87 patients, of which 15% were due to cardiac toxicity. Conclusions: The incidence of cardiac toxicity is high, especially in patients with multiple ASCVD risk factors or AFib, and is often the reason for ICI discontinuation, warranting close surveillance prior to and during therapy. Cardiac evaluation and monitoring for cardiotoxicity were infrequent in patients receiving ICI therapy, despite the high prevalence of ASCVD in this population.