Waheed Nida, Fradley Michael G, DeRemer David L, Mahmoud Ahmad, Shah Chintan P, Langaee Taimour Y, Lipori Gloria P, March Keith, Pepine Carl J, Cooper-DeHoff Rhonda M, Wu Yonghui, Gong Yan
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Cardiooncology. 2021 Mar 18;7(1):10. doi: 10.1186/s40959-021-00097-9.
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.
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.
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).
This study suggests a high incidence of newly diagnosed cardiovascular disease after the initiation of ICI therapy in a real-world clinical setting.
免疫检查点抑制剂（ICIs）是一类新型抗癌药物，已在实体瘤和血液系统恶性肿瘤中显示出临床疗效。ICIs与包括心脏毒性在内的免疫相关不良事件的发生有关。我们在一家大型三级医疗中心估计了接受ICIs治疗的患者中新诊断心血管疾病的发生率。
纳入2011年至2017年在佛罗里达大学综合数据存储库中接受任何ICI治疗的所有癌症诊断患者。心血管疾病定义为ICI治疗开始后新出现的心肌病、心力衰竭、心律失常、心脏传导阻滞、心包疾病或心肌炎的ICD诊断代码。
在102,701例恶性肿瘤诊断患者中，424例接受了至少一种ICI。62例（14.6%）患者在ICI治疗开始后被诊断出至少一种新的心血管疾病。在接受一种ICI的374例患者中，21例（5.6%）发生心力衰竭。在依次接受两种ICI的49例患者中，3例（6.1%）发生心力衰竭和/或心肌病。首次接触ICI后中位63天诊断出心血管疾病。1例患者在接受纳武单抗28天后发生心肌炎。与未合并心血管疾病的ICI治疗患者相比，合并心血管疾病的ICI治疗患者死亡率更高（66.1%对41.4%，优势比=2.77，1.55 - 4.95，p = 0.0006）。
本研究表明，在真实世界临床环境中，ICI治疗开始后新诊断心血管疾病的发生率较高。
