Maria D'Souza1, Dorte Nielsen2, Inge Marie Svane2, Kasper Iversen1, Peter Vibe Rasmussen1, Christian Madelaire1, Emil Fosbøl3, Lars Køber3, Finn Gustafsson3, Charlotte Andersson1,4, Gunnar Gislason1,5, Christian Torp-Pedersen6, Morten Schou1. 1. Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Forskning 1, 2900 Hellerup, Denmark. 2. Department of Clinical Oncology, Copenhagen University Hospital Herlev-Gentofte, Forskning 1, 2900 Hellerup, Denmark. 3. Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. 4. Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. 5. The Danish Heart Foundation, Copenhagen, Denmark. 6. Department of Cardiology, Hillerød Hospital, Denmark.
Abstract
AIMS: The study aimed to estimate the risk of cardiac events in immune checkpoint inhibitor (ICI)-treated patients with lung cancer or malignant melanoma. METHODS AND RESULTS: The study included consecutive patients with lung cancer or malignant melanoma in 2011-17 nationwide in Denmark. The main composite outcome was cardiac events (arrhythmia, peri- or myocarditis, heart failure) or cardiovascular death. Absolute risks were estimated and the association of ICI and cardiac events was analysed in multivariable Cox models. We included 25 573 patients with lung cancer. Of these, 743 were treated with programmed cell death-1 inhibitor (PD1i) and their 1-year absolute risk of cardiac events was 9.7% [95% confidence interval (CI) 6.8-12.5]. Of the 13 568 patients with malignant melanoma, 145 had PD1i and 212 had cytotoxic T-lymphocyte-associated protein-4 inhibitor (CTLA-4i) treatment. Their 1-year risks were 6.6% (1.8-11.3) and 7.5% (3.7-11.3). The hazard rates of cardiac events were higher in patients with vs. without ICI treatment. Within 6 months from 1st ICI administration, the hazard ratios were 2.14 (95% CI 1.50-3.05) in patients with lung cancer and 4.30 (1.38-13.42) and 4.93 (2.45-9.94) in patients with malignant melanoma with PD1i and CTLA-4i, respectively. After 6 months, HRs were 2.26 (1.27-4.02) for patients with lung cancer and 3.48 (1.91-6.35) for patients with malignant melanoma and CTLA-4i. CONCLUSIONS: Among patients with lung cancer and malignant melanoma, ICI treated had increased rates of cardiac events. The absolute risks were higher in these data compared with previous pharmacovigilance studies (e.g. 1.8% peri-/myocarditis 1-year risk). Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The study aimed to estimate the risk of cardiac events in immune checkpoint inhibitor (ICI)-treated patients with lung cancer or malignant melanoma. METHODS AND RESULTS: The study included consecutive patients with lung cancer or malignant melanoma in 2011-17 nationwide in Denmark. The main composite outcome was cardiac events (arrhythmia, peri- or myocarditis, heart failure) or cardiovascular death. Absolute risks were estimated and the association of ICI and cardiac events was analysed in multivariable Cox models. We included 25 573 patients with lung cancer. Of these, 743 were treated with programmed cell death-1 inhibitor (PD1i) and their 1-year absolute risk of cardiac events was 9.7% [95% confidence interval (CI) 6.8-12.5]. Of the 13 568 patients with malignant melanoma, 145 had PD1i and 212 had cytotoxic T-lymphocyte-associated protein-4 inhibitor (CTLA-4i) treatment. Their 1-year risks were 6.6% (1.8-11.3) and 7.5% (3.7-11.3). The hazard rates of cardiac events were higher in patients with vs. without ICI treatment. Within 6 months from 1st ICI administration, the hazard ratios were 2.14 (95% CI 1.50-3.05) in patients with lung cancer and 4.30 (1.38-13.42) and 4.93 (2.45-9.94) in patients with malignant melanoma with PD1i and CTLA-4i, respectively. After 6 months, HRs were 2.26 (1.27-4.02) for patients with lung cancer and 3.48 (1.91-6.35) for patients with malignant melanoma and CTLA-4i. CONCLUSIONS: Among patients with lung cancer and malignant melanoma, ICI treated had increased rates of cardiac events. The absolute risks were higher in these data compared with previous pharmacovigilance studies (e.g. 1.8% peri-/myocarditis 1-year risk). Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Johannes R Madsen; Jacob P S Nielsen; Kamille Fogh; Cecilie B Hansen; Pernille B Nielsen; Theis Lange; Rasmus B Hasselbalch; Peter Garred; Kasper Iversen Journal: Open Forum Infect Dis Date: 2021-08-19 Impact factor: 3.835
Authors: Jingyi Gong; Zsofia Dora Drobni; Amna Zafar; Thiago Quinaglia; Sarah Hartmann; Hannah K Gilman; Vineet K Raghu; Carlos Gongora; Meghan E Sise; Raza M Alvi; Leyre Zubiri; Anju Nohria; Ryan Sullivan; Kerry L Reynolds; Daniel Zlotoff; Tomas G Neilan Journal: J Immunother Cancer Date: 2021-06 Impact factor: 13.751