Immune checkpoint inhibitors increase risk of myocarditis, arrhythmias, heart failure and CV death
Immune checkpoint inhibitor (ICI) therapy is a popular, effective treatment for a variety of cancers. However, according to a new analysis in European Heart Journal, some patients undergoing ICI therapy may face an increased risk of cardiac events such as myocarditis, arrhythmias, heart failure and cardiovascular death.
The study’s authors tracked data from more than 13,000 consecutive patients with malignant melanoma and more than 25,000 consecutive patients with lung cancer. All patients received care in Denmark from 2011 to 2017. A total of 357 patients with malignant melanoma received ICI treatment, and 746 patients with lung cancer received ICI treatment.
Patients with malignant melanoma who underwent ICI therapy were treated with a programmed cell death-1 inhibitor (PD1i)—either pembrolizumab or nivolumab—or a cytotoxic T-lymphocyte-associated protein-4 inhibitor (CTLA4i). Patients saw their risk of cardiac events increase four-fold in the first six months after PD1i or CTLA41 treatment.
Almost all lung cancer patients undergoing ICI therapy received treatment with pembrolizumab or nivolumab, and those patients had “an overall lower burden of comorbidities compared to other lung cancer patients.” The patients given a PD1i had a two-fold increase in their risk of cardiac events.
“It has been suspected that most cardiac side effects occur early after treatment within the first week to months,” wrote lead author Maria D’Souza, a cardiologist at Gentofte Hospital in Denmark, and colleagues. “Our results suggest that increased rates of cardiac events are also seen after the initial six months of the first administration. This prolonged increased risk may reflect that the data in this study were all hospitalizations not limited to adverse event registration in pharmacovigilance data.”
In the near future, the team added, studies on newer treatments such as dual checkpoint blockade and atezolizumab will also be needed.
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.