ICIs associated with increased MACE risk

Author: Shreeya Nanda

medwireNews: People with cancer receiving immune checkpoint inhibitors (ICIs) have a significantly higher risk for major adverse cardiovascular events (MACE) than their unexposed counterparts or the general population, indicate real-world findings.

“Cardiovascular events during and after ICI treatment are more common than currently appreciated,” based on clinical trial data, and the risk is especially pronounced for those with a history of cardiovascular disease, say Dorien Laenens (University Hospitals Leuven, Belgium) and team in the Journal of Clinical Oncology.

The study included data on 672 patients who received ICI treatment at University Hospitals Leuven between June 2010 and January 2020. The mean age of the participants was 64.8 years and just under two-thirds (64.7%) were men. The most common tumor type in the cohort was non-small-cell lung cancer, in 40.9%, followed by malignant melanoma (31.9%) and renal cell carcinoma (20.2%).

Over a median follow-up of 13 months, the composite endpoint of MACE – which included fatal and nonfatal acute coronary syndrome, heart failure, and stroke or transient ischemic attack – occurred in 10.3% of the cohort.

The researchers highlight that although the overall mortality rate in the cohort was high, at 54.9%, the rate of cardiovascular mortality was low, at 1.9%.

They also investigated risk factors for MACE, finding that age, history of heart failure, and history of valvular heart disease were significantly associated with an elevated risk in a multivariable analysis, with hazard ratios (HRs) of 1.03, 2.27, and 3.01, respectively.

The team then matched 421 of the ICI-treated patients by age (within 5 years), sex, history of cardiovascular disease, and cancer type (where relevant) to 396 cancer patients not treated with ICIs and 399 cancer-free individuals from the population-based FLEMENGHO study.

The risk for MACE was a significant 39% lower among patients who were not exposed to ICIs than those who were, a reduction that was primarily driven by a 45% lower, albeit nonsignificant, risk for heart failure in the non-ICI group, report Laenens et al.

“This suggests a harmful effect of ICI treatment besides the underlying risk profile,” they say, adding that “[a] larger study sample might have exposed a statistical difference.”

The MACE risk was also reduced among the cancer-free controls versus ICI users, by a significant 76%.

In conclusion, Laenens and colleagues say that “[a] routine thorough cardiovascular history, [electrocardiogram], and echocardiography might identify patients who need a regular cardiovascular follow-up during and after ICI treatment.”

And they add: “However, it remains unknown if treating modifiable risk factors and cardiovascular disease before starting ICI will reduce the incidence of adverse cardiovascular events.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

J Clin Oncol 2022; doi:10.1200/JCO.21.01808

Image Credits: © MarsBars / Getty Images / iStock

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