Cardiovascular adverse events are associated with usage of immune checkpoint inhibitors in real-world clinical data across the United States.

Abstract

BACKGROUND:

Immune checkpoint inhibitors (ICIs) can cause life-threatening cardiovascular adverse events (CVAEs) that may not be attributed to therapy. The outcomes of clinical trials may underestimate treatment-related adverse events due to restrictive eligibility, limited sample size, and failure to anticipate selected toxicities. We evaluated the incidence and clinical determinants of CVAEs in real-world population on ICI therapy.

PATIENTS AND METHODS:

Among 2 687 301 patients diagnosed with cancer from 2011 to 2018, 16 574 received ICIs for any cancer. Patients in the ICI and non-ICI cohorts were matched in a 1 : 1 ratio according to age, sex, National Cancer Institute comorbidity score, and primary cancer. The non-ICI cohort was stratified into patients who received chemotherapy (N = 2875) or targeted agents (N = 4611). All CVAEs, non-cardiac immune-related adverse events occurring after treatment initiation, baseline comorbidities, and treatment details were identified and analyzed using diagnosis and billing codes.

RESULTS:

Median age was 61 and 65 years in the ICI and non-ICI cohorts, respectively (P < 0.001). ICI patients were predominantly male (P < 0.001). Lung cancer (43.1%), melanoma (30.4%), and renal cell carcinoma (9.9%) were the most common cancer types. CVAE diagnoses in our dataset by incidence proportion (ICI cohort) were stroke (4.6%), heart failure (3.5%), atrial fibrillation (2.1%), conduction disorders (1.5%), myocardial infarction (0.9%), myocarditis (0.05%), vasculitis (0.05%), and pericarditis (0.2%). Anti-cytotoxic T-lymphocyte-associated protein 4 increased the risk of heart failure [versus anti-programmed cell death protein 1; hazard ratio (HR), 1.9; 95% confidence interval (CI) 1.27-2.84] and stroke (HR, 1.7; 95% CI 1.3-2.22). Pneumonitis was associated with heart failure (HR, 2.61; 95% CI 1.23-5.52) and encephalitis with conduction disorders (HR, 4.35; 95% CI 1.6-11.87) in patients on ICIs. Advanced age, primary cancer, nephritis, and anti-cytotoxic T-lymphocyte-associated protein 4 therapy were commonly associated with CVAEs in the adjusted Cox proportional hazards model.

CONCLUSIONS:

Our findings underscore the importance of risk stratification and cardiovascular monitoring for patients on ICI therapy.

• Authors: P Jain, J Gutierrez Bugarin, A Guha, C Jain, N Patil, T Shen, I Stanevich, V Nikore, K Margolin, M Ernstoff, V Velcheti, J Barnholtz-Sloan, A Dowlati
• Journal: ESMO open (ESMO Open) Vol. 6 Issue 5 Pg. 100252 (10 2021) ISSN: 2059-7029 [Electronic] England
• PMID: 34461483 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Immune Checkpoint Inhibitors

Topics

• Aged
• Carcinoma, Renal Cell
• Humans
• Immune Checkpoint Inhibitors
• Kidney Neoplasms
• Lung Neoplasms (drug therapy)
• Male
• Melanoma
• Middle Aged
• United States (epidemiology)