Newly diagnosed cardiovascular disease in patients treated with immune checkpoint inhibitors: a retrospective analysis of patients at an academic tertiary care center

Cardio-Oncology

Michael G. Fradley¹  Taimour Y. Langaee²  Rhonda M. Cooper-DeHoff³  David L. DeRemer⁴  Yan Gong⁵  Nida Waheed⁶  Carl J. Pepine⁷  Ahmad Mahmoud⁷  Keith March⁷  Chintan P. Shah⁸  Yonghui Wu⁹  Gloria P. Lipori^1,10 

[1] Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA;Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, PO Box 100486, 1345 Center Drive, 32610-0486, Gainesville, FL, USA;Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA;Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, PO Box 100486, 1345 Center Drive, 32610-0486, Gainesville, FL, USA;Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA;Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA;Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, PO Box 100486, 1345 Center Drive, 32610-0486, Gainesville, FL, USA;UF Health Cancer Center, Gainesville, Florida, USA;Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, PO Box 100486, 1345 Center Drive, 32610-0486, Gainesville, FL, USA;UF Health Cancer Center, Gainesville, Florida, USA;Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA;Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA;Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA;Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA;Health Outcome and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA;UF Health, Gainesville, Florida, USA;Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA;

关键词: Cardio-oncology;    Immune checkpoint inhibitors;    Cardiomyopathy;    Heart failure;   

DOI  :  10.1186/s40959-021-00097-9

来源: Springer

【 摘 要 】

BackgroundImmune checkpoint inhibitors (ICIs) are a novel class of anticancer agents that have demonstrated clinical response for both solid and hematological malignancies. ICIs are associated with development of immune-related adverse events including cardiotoxicity. We estimated the incidence of newly diagnosed cardiovascular disease in patients treated with ICIs at a large, tertiary care center.MethodsAll patients with a cancer diagnosis who received any ICI treatment in the University of Florida’s Integrated Data Repository from 2011 to 2017 were included. Cardiovascular disease was defined as a new ICD diagnosis code for cardiomyopathy, heart failure, arrhythmia, heart block, pericardial disease, or myocarditis after initiation of ICI treatment.ResultsOf 102,701 patients with a diagnosis of malignancy, 424 patients received at least one ICI. Sixty-two (14.6%) patients were diagnosed with at least one new cardiovascular disease after initiation of ICI therapy. Of the 374 patients receiving one ICI, 21 (5.6%) developed heart failure. Of the 49 patients who received two ICIs sequentially, three (6.1%) developed heart failure and/or cardiomyopathy. Incident cardiovascular disease was diagnosed at a median of 63 days after initial ICI exposure. One patient developed myocarditis 28 days after receiving nivolumab. Mortality in ICI treated patients with a concomitant diagnosis of incident cardiovascular disease was higher compared to those who did not (66.1% vs. 41.4%, odds ratio = 2.77, 1.55–4.95, p = 0.0006).ConclusionsThis study suggests a high incidence of newly diagnosed cardiovascular disease after the initiation of ICI therapy in a real-world clinical setting.

【 授权许可】

CC BY