Risk of Cardiac Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Regimens: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:

We performed a systematic review and meta-analysis to evaluate the risks of cardiac adverse events in solid tumor patients treated with monotherapy of immune checkpoint inhibitors (ICIs) or combined therapy of ICIs plus chemotherapy.

METHODS:

Eligible studies were selected through the following databases: PubMed, Embase and clinical trials (https://clinicaltrials.gov.) and included phase III/IV randomized controlled trials (RCTs) involving patients with the solid tumor treated with ICIs. The data was analyzed by using Review Manager (version5.3), Stata (version 15.1).

RESULTS:

Among 2,551 studies, 25 clinical trials including 20,244 patients were qualified for the meta-analysis. Compared with PD-1 inhibitor (nivolumab) or CTLA-4 inhibitor (ipilimumab), PD-1 inhibitor (nivolumab) plus CTLA-4 inhibitor (ipilimumab) combined therapy showed significant increase in grade 5 arrhythmology (OR 3.90, 95% CI: 1.08-14.06, p = 0.603). PD-1 inhibitor plus chemotherapy show significant increase in grades 1-5 myocardial disease (OR 5.09, 95% CI: 1.11-23.32, p = 1.000). Compared with chemotherapy, PD-1 inhibitor (nivolumab) or CTLA-4 inhibitor (ipilimumab), PD-1 inhibitor (nivolumab) plus CTLA-4 inhibitor (ipilimumab) combined therapy show significant increase in grades 1-5 arrhythmology (OR 2.49, 95% CI: 1.30-4.78, p = 0.289).

CONCLUSIONS:

Our meta-analysis demonstrated that PD-1 inhibitor plus CTLA-4 inhibitor can result in a higher risk of grade 5 arrhythmology in comparison with PD-1/CTLA-4 inhibitor alone, and a higher risk of grade 5 arrhythmology in comparison with chemotherapy. PD-1 inhibitor plus chemotherapy treatment could increase the risk of all-grade myocardial disease compared with chemotherapy. However, in most cases, there was no significant increase of risks of cardiovascular toxicity in PD-1/PD-L1 inhibitor monotherapy or PD-1/PD-L1 inhibitor plus chemotherapy compared with chemotherapy alone.

• Authors: Jiexuan Hu, Ruyue Tian, Yingjie Ma, Hongchao Zhen, Xiao Ma, Qiang Su, Bangwei Cao
• Journal: Frontiers in oncology (Front Oncol) Vol. 11 Pg. 645245 ( 2021) ISSN: 2234-943X [Print] Switzerland
• PMID: 34123795 (Publication Type: Systematic Review)
• Copyright: Copyright © 2021 Hu, Tian, Ma, Zhen, Ma, Su and Cao.