Chan Jeffrey Shi Kai, Tang Pias, Ng Kenrick, Dee Edward Christopher, Lee Teddy Tai Loy, Chou Oscar Hou In, Lee Yan Hiu Athena, Lau Dawnie Ho Hei, Liu Tong, Tse Gary
Cardio-oncology Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China. Electronic address: https://twitter.com/@JeffreyChansky.
Cardio-oncology Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China.
Lung Cancer. 2022 Dec;174:67-70. doi: 10.1016/j.lungcan.2022.10.010. Epub 2022 Nov 1.
Despite their proven efficacy for treating lung cancer, the cardiovascular risks associated with programmed cell death protein 1 (PD-1) inhibitors and their combinations with chemotherapy (chemo-immunotherapy) are unclear. This study aimed to investigate these associations.
This retrospective cohort study included Hong Kong patients with lung cancer receiving PD-1 inhibitors during 2013-2021. Patients with non-concurrent use of PD-1 inhibitors and chemotherapy, any use of tyrosine kinase inhibitors or other immunotherapy agents, and those with prior stroke, heart failure, or myocardial infarction were excluded. PD-1 inhibitors and chemo-immunotherapy were compared for major adverse cardiovascular events (MACE), a composite of cardiovascular mortality, heart failure, stroke, and myocardial infarction. All patients were followed up until the end of 2021. Inverse probability of treatment weighting was used to balance covariates between the two treatment groups.
In total, 713 patients (333 PD-1 inhibitors users and 380 chemo-immunotherapy users) were analysed. Over a mean follow-up of 1.4 ± 1.3 years, 24 had MACE, with an observed incidence of 2.8 [1.6-4.8] events per 100 person-year for patients on PD-1 inhibitors, and 2.1 [1.2-3.8] per 100 person-year for patients on chemo-immunotherapy. No significant between-group difference in MACE incidence was observed (log-rank p = 0.641).
The cardiovascular risks associated with PD-1 inhibitors and chemo-immunotherapy may not be significantly different amongst patients with lung cancer. Cardiovascular events associated with either regimen may be uncommon.
尽管程序性细胞死亡蛋白1（PD-1）抑制剂及其与化疗联合使用（化疗免疫疗法）在治疗肺癌方面已被证实有效，但其相关的心血管风险尚不清楚。本研究旨在调查这些关联。
这项回顾性队列研究纳入了2013年至2021年期间在香港接受PD-1抑制剂治疗的肺癌患者。排除了非同时使用PD-1抑制剂和化疗的患者、任何使用酪氨酸激酶抑制剂或其他免疫治疗药物的患者，以及既往有中风、心力衰竭或心肌梗死的患者。比较了PD-1抑制剂和化疗免疫疗法的主要不良心血管事件（MACE），MACE是心血管死亡率、心力衰竭、中风和心肌梗死的综合指标。所有患者随访至2021年底。采用治疗权重逆概率法来平衡两个治疗组之间的协变量。
共分析了713例患者（333例使用PD-1抑制剂，380例使用化疗免疫疗法）。平均随访1.4±1.3年，24例发生MACE，PD-1抑制剂治疗患者每100人年的观察发病率为2.8[1.6-4.8]例，化疗免疫疗法治疗患者每100人年为2.1[1.2-3.8]例。未观察到两组间MACE发病率的显著差异（对数秩检验p=0.641）。
在肺癌患者中，PD-1抑制剂和化疗免疫疗法相关的心血管风险可能无显著差异。与这两种治疗方案相关的心血管事件可能并不常见。
