Cardiotoxicity of Immune Checkpoint Inhibitors in Patients with Lung Cancer

Abstract

Background Immune checkpoint inhibitors (ICIs) activate the host immune system to target cancer cells. However, the unchecked systemic inflammatory response may result in cardiovascular immune-related adverse events, as myocarditis, pericardial disease, stress-induced, and dilated cardiomyopathy are increasingly reported in case series and pharmacovigilance databases. We sought to further investigate ICI-related cardiotoxicity in a cohort of patients with lung cancer. Methods We performed a retrospective analysis of patients with a pathologically confirmed diagnosis of primary lung cancer treated with ICIs or non-ICI systemic therapy over three years to assess the likelihood of major adverse cardiovascular events, defined as cardiovascular death, non-fatal MI, non-fatal stroke, and hospitalization for heart failure. Data was collected on co-morbidities, cardiovascular medications, past or concurrent radiation or systemic therapies, serum troponin, brain natriuretic peptide levels, pre- and post-treatment electrocardiograms, echocardiography, angiography, and total ICI dose. Each factor was compared between patients treated with ICIs and non-ICI systemic therapy. Results We included 252 patients in our study. During a median follow-up of 6 months (interquartile range: 2-14 months), patients treated with ICIs (n = 135) who had a troponin elevation were more likely to sustain a MACE (hazard ratio: 6.9, 95% confidence interval: 3.2-15, p Discussion Patients with lung cancer on ICIs are more likely to incur a troponin elevation compared to patients on conventional chemotherapy. Elevated troponin is associated with an increased likelihood of MACE, especially early during treatment with ICIs. This data supports closer monitoring, including serial troponin measurements during the early phase of ICI therapy.