Zhang Xiao-Tong, Ge Nan, Xiang Zi-Jian, Liu Tao
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Cell Int. 2022 Nov 19;22(1):363. doi: 10.1186/s12935-022-02760-2.
Although people are more and more aware of the cardiotoxicity caused by immune checkpoint inhibitors (ICIs) in the treatment of lung cancer, its incidence rate has not been systematically analyzed. This study aims to evaluate the incidence of cardiotoxicity related to the ICI therapies for lung cancer, so as to enhance clinicians' attention to cardiotoxicity, implement proper prevention and intervention for high-risk patients, and minimize the risk of cardiac dysfunction during and after completion of therapy.
We conducted a systematic literature search for relevant publications in PubMed and Scopus from inception to 19 April 2022. Pooled incidence and risk ratios with 95% confidence intervals (95% CIs) for cardiotoxicity events were calculated.
A total of 37 studies covering 38 trials, including 14,342 patients, were identified. The pooled risk ratios of incidence of any cardiac AEs were 1.944 [95% CI 0.8-4.725] (Single ICI versus chemotherapy), 1.677 [95% CI 1.065-2.64] (Single ICI plus chemotherapy versus chemotherapy), and 0.478 [95% CI 0.127-1.798] (Single ICI versus Dual ICI). The incidence of myocarditis and arrhythmia were 0.003[95%CI 0.002-0.006] and 0.014[95%CI 0-0.037], respectively.
Single ICI did not increase the risk of cardiotoxicity compared with chemotherapy, and single ICI plus chemotherapy increased the risk of cardiotoxicity by 67% compared with chemotherapy alone. Combination immunotherapy did not increase the risk of cardiotoxicity compared with single ICI.
尽管人们越来越意识到免疫检查点抑制剂（ICI）治疗肺癌时引起的心脏毒性，但其发生率尚未得到系统分析。本研究旨在评估肺癌ICI治疗相关心脏毒性的发生率，以提高临床医生对心脏毒性的关注，对高危患者实施适当的预防和干预，并在治疗期间及完成后将心脏功能障碍的风险降至最低。
我们在PubMed和Scopus中对从创刊至2022年4月19日的相关出版物进行了系统的文献检索。计算了心脏毒性事件的合并发生率和95%置信区间（95%CI）的风险比。
共纳入37项研究，涵盖38项试验，包括14342例患者。任何心脏不良事件发生率的合并风险比为1.944 [95%CI 0.8 - 4.725]（单药ICI与化疗相比）、1.677 [95%CI 1.065 - 2.64]（单药ICI加化疗与化疗相比）和0.478 [95%CI 0.127 - 1.798]（单药ICI与双药ICI相比）。心肌炎和心律失常的发生率分别为0.003[95%CI 0.002 - 0.006]和0.014[95%CI 0 - 0.037]。
与化疗相比，单药ICI未增加心脏毒性风险；与单纯化疗相比，单药ICI加化疗使心脏毒性风险增加67%。与单药ICI相比，联合免疫治疗未增加心脏毒性风险。
