Abstract
We aimed to evaluate whether therapy with immune checkpoint inhibitors (ICI) leads to changes in electrocardiogram (ECG) parameters in melanoma patients. We retrospectively examined 41 patients (46% women, age 61 ± 12years) with advanced melanoma (stage III/IV) before and during ICI treatment from our “Essen Cardio-oncology Registry” (ECoR). ECGs were analyzed before and 4–12 weeks after therapy started (follow-up, 90 ± 51 days). Heart rate, PR time, QRS duration and duration of the corrected QT (QTc) interval were recorded. QT dispersion (QTd) was calculated. Heart rate, PR time, QRS and QTc did not differ when comparing values before and after therapy started. QTd was prolonged after therapy started (32 ± 16 ms vs. 47 ± 19 ms, n = 41, p < 0.0001). Subgroup analyses revealed prolonged QTd in patients that received a combination immunotherapy with ipilimumab and nivolumab (31 ± 14 ms vs. 50 ± 14 ms, n = 21, p < 0.0001), while QTd in patients with anti–programmed death 1 (PD-1) inhibitor monotherapy did not change after therapy started. QTd is prolonged in patients under ICI combination therapy, potentially signaling an increased susceptibility to ventricular arrhythmias.
Highlights
About 232,100 cases of cutaneous melanoma are diagnosed every year [1]
The cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) inhibitor, ipilimumab, and the programmed death 1 (PD-1) inhibitors, nivolumab and pembrolizumab, or combinations of these agents are applied in patients with advanced melanoma [2,3,4]
Half of them received the PD-1 inhibitor, nivolumab, as monotherapy, the other half received a combination therapy consisting of nivolumab and the CTLA-4 inhibitor, ipilimumab
Summary
About 232,100 cases of cutaneous melanoma are diagnosed every year [1]. Over the past few years, two treatment strategies have revolutionized melanoma therapy. Treatments targeting B-raf proto-oncogene serine/threonine-kinase (BRAF) in combination with mitogen-activated protein kinase MEK 1 inhibitors (MEKI) have improved treatment response and overall survival [1]. Improvement of prognosis in advanced melanoma has been further driven by immune checkpoint inhibitor (ICI) therapies [1]. ICI typically targets cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) and anti–programmed death 1/ligand-1 (PD-1/PD-L1). The CTLA-4 inhibitor, ipilimumab, and the PD-1 inhibitors, nivolumab and pembrolizumab, or combinations of these agents are applied in patients with advanced melanoma [2,3,4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
