Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan.
Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan.
Oncologist. 2022 May 6;27(5):e410-e419. doi: 10.1093/oncolo/oyac056.
Cardiovascular immune-related adverse events (CV-irAEs) associated with immune checkpoint inhibitors (ICIs) may have been underreported given that most previous reports were retrospective. We aimed to evaluate the incidence, clinical characteristics, and predictors of CV-irAEs and determine the feasibility of serial cardiac monitoring using a combination of B-type natriuretic peptide, cardiac troponin T, and electrocardiogram for the prediction of future symptomatic (grade ≥2) CV-irAEs.
This was a prospective observational study that included 129 consecutive patients with non-small-cell lung cancer who received ICI monotherapy at a single center. Serial cardiac monitoring was performed during ICI monotherapy.
A total of 35 (27%) patients developed any grade ≥1 CV-irAEs with a median time of onset of 72 (interquartile range 44-216) days after ICI treatment initiation. Multivariate Fine-Gray regression analysis showed that prior acute coronary syndrome (adjusted hazard ratio [HR] 3.15 (95% [CI], 2.03-4.91), prior heart failure hospitalization (adjusted HR 1.65 [95% CI, 1.17-2.33]), and achievement of disease control (adjusted HR 1.91, [95% CI, 1.16-3.14]) were significantly associated with grade ≥1 CV-irAEs. Serial cardiac monitoring revealed that patients with preceding grade 1 CV-irAEs were associated with a significantly higher risk of onset of grade ≥2 CV-irAEs compared with those without preceding grade 1 CV-irAEs (HR: 6.17 [95% CI, 2.97-12.83]).
CV-irAEs were more common than previously recognized and have several predictors. Moreover, serial cardiac monitoring may be feasible for the prediction of future grade ≥2 CV-irAEs.
心血管免疫相关不良事件（CV-irAEs）与免疫检查点抑制剂（ICIs）相关，由于之前的大多数报告都是回顾性的，因此可能报告不足。我们旨在评估 CV-irAEs 的发生率、临床特征和预测因素，并确定使用 B 型利钠肽、心肌肌钙蛋白 T 和心电图联合进行连续心脏监测，预测未来有症状（≥2 级）CV-irAEs 的可行性。
这是一项单中心连续纳入 129 例接受单药免疫检查点抑制剂治疗的非小细胞肺癌患者的前瞻性观察性研究。在单药免疫检查点抑制剂治疗期间进行连续心脏监测。
共有 35 例（27%）患者出现任何级别≥1 的 CV-irAEs，ICI 治疗开始后中位发病时间为 72 天（四分位距 44-216 天）。多变量 Fine-Gray 回归分析显示，既往急性冠状动脉综合征（调整后的危险比 [HR] 3.15（95% [CI]，2.03-4.91））、心力衰竭住院（调整后的 HR 1.65 [95% CI]，1.17-2.33））和疾病控制（调整后的 HR 1.91 [95% CI]，1.16-3.14））与任何级别≥1 的 CV-irAEs 显著相关。连续心脏监测显示，与没有先前 1 级 CV-irAEs 的患者相比，先前发生 1 级 CV-irAEs 的患者发生≥2 级 CV-irAEs 的风险显著更高（HR：6.17 [95% CI]，2.97-12.83）。
CV-irAEs 比以前认识到的更为常见，并且有几个预测因素。此外，连续心脏监测可能可用于预测未来的≥2 级 CV-irAEs。
