Gender differences in cardio-oncology care of patients treated with immune checkpoint inhibitor therapy

Abstract

Abstract Background Immune checkpoint inhibitor (ICI) therapy has significantly improved survival in patients with different cancer entities. It is estimated that nearly half of the patients with advanced cancer will be eligible for immunotherapy in the near future. Cancer therapy-related cardiovascular toxicity (CTR-CVT) could significantly increase morbidity and mortality in this patient population. There is limited knowledge regarding the impact of gender on the development of CTR-CVT under ICI therapy, since there are studies suggesting different immune responses between females and males. Aim To identify gender differences in the incidence of CTR-CVT and survival rates in patients with cancer under ICI therapy from the local Essen cardio-oncology Registry (EcoR) database. Results 1443 cardio-oncology patients were included in the EcoR from 2018 until 2021. 353 patients (24.4%, evaluated through 864 consultations) were treated with ICI therapy. The study population included 38% females vs. 62% males (p < 0.001), 61 ± 13 years vs. 63 ± 13 years (p = 0.077), 72.4% vs. 72.6% metastatic disease (p = 0.802) respectively. 74.2% patients presented with malignant melanoma (78.4% females vs. 71.7% males, p = 0.169), 7.1% with non-small cell lung cancer, 6.5% with squamous cell carcinoma, 5.4% with Merkel cell carcinoma, 3.4% with hepatocellular carcinoma, 1.1% with oropharynx carcinoma and 2.4% with other cancer entities. Male patients showed a higher incidence of arterial hypertension, coronary artery disease, atrial fibrillation and permanent pacing. Additionally, LVEF at baseline was reduced in the male population (Table 1). There was no difference in the ICI regimen between males and females (Table 2). Females and males showed the same incidence of CTR-CVT, including myocarditis (Figure 1) and the same one-year survival rate (87.3% survival in females vs. 84.5% survival in males, p = 0.531). Conclusion Females showed similar rates of CVR-CVT and one-year survival compared to male population, despite higher incidence of cardiovascular risk factors and pre-existent cardio-vascular disease in the male population. Further studies should assess gender-specific causes of this difference.Figure 1Tables 1 and 2