Abstract
Introduction: Chemo-immunotherapy combinations have proven efficacious for treating advanced lung cancer. However, their cardiovascular risks are unclear. This study thus aimed to compare the cardiovascular risks between programmed cell death protein 1 (PD-1) inhibitors, and chemo-immunotherapy in Asian patients with lung cancer. Methods: This retrospective cohort study included patients aged at least 18 years old with lung cancer receiving any PD-1 inhibitor in Hong Kong during 2013-2021. Patients with non-concurrent use of PD-1 inhibitor and chemotherapy, use of tyrosine kinase inhibitor, other immunotherapy, or those with prior stroke, heart failure, or myocardial infarction were excluded. Treatment groups were defined as PD-1 inhibitor only, and concurrent use of PD-1 inhibitor and chemotherapy (chemo-immunotherapy). The endpoint was major adverse cardiovascular events (MACE), that was the first occurrence of cardiovascular death, heart failure, stroke, or myocardial infarction. Patients were followed up until the end of 2021. Inverse probability treatment weighting (IPTW) was used to minimise covariate imbalances. Results: Of the 1508 patients identified, 713 were analysed (538 male, mean age 66.2±10.6 years old, mean follow up 1.4±1.3 years); 333 received PD-1 inhibitors only, and 380 received chemo-immunotherapy. IPTW achieved good balance for all covariates. The observed incidence rate of MACE was 2.8 events per 100 person-year (95% confidence interval (CI) 1.6-4.8) for patients on PD-1 inhibitors, and 2.1 per 100 person-year (95% CI 1.2-3.8) for those on chemo-immunotherapy. The log-rank test showed no significant difference in cumulative incidence of MACE between treatment groups (p=0.641; Figure 1). Conclusions: MACE may be uncommon amongst patients with lung cancer receiving PD-1 inhibitors or chemo-immunotherapy. The associated risks of MACE may not be significantly different between PD-1 inhibitors and chemo-immunotherapy.
Published Version
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