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

• Authors: Nida Waheed, Emory University; Michael G Fradley, University of Pennsylvania, Philadelphia; David L DeRemer, University of Florida; Ahmad Mahmoud, University of Florida, Gainesville; Chintan P Shah, University of Florida, Gainesville; Taimour Y Langaee, University of Florida, Gainesville; Gloria P Lipori, University of Florida, Gainesville; Keith March, University of Florida, Gainesville; Carl J Pepine, University of Florida, Gainesville; Rhonda M Cooper-DeHoff, University of Florida, Gainesville; Yonghui Wu, University of Florida, Gainesville; Yan Gong, University of Florida, Gainesville
• Journal Title: Cardio-Oncology
• Volume: Volume 7
• Publisher: BMC | 2021-03-18
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s40959-021-00097-9
• Subjects: Health Sciences, Oncology; Chemistry, Pharmaceutical
• Keywords: Cardio-oncology; Immune checkpoint inhibitors; Cardiomyopathy; Heart failure

Abstract

Background Immune 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. Methods All 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. Results Of 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). Conclusions This study suggests a high incidence of newly diagnosed cardiovascular disease after the initiation of ICI therapy in a real-world clinical setting.