Son Christine, Moey Melissa Y Y, Walker Paul R, Naqash Abdul R, Peach Matthew Sean, Ju Andrew W
Brody School of Medicine at East Carolina University, Greenville, NC, United States.
Department of Cardiovascular Sciences at Vidant Medical Center/East Carolina University, Greenville, NC, United States.
Front Oncol. 2023 Jan 9;12:1025455. doi: 10.3389/fonc.2022.1025455. eCollection 2022.
Immune checkpoint inhibitors (ICIs) are used to treat locally-advanced and metastatic lung cancer, which can lead to severe immunogenic-related cardiotoxicities. We assessed the risk of cardiotoxicity in ICI-treated lung cancer patients with or without cardiac radiation from thoracic radiotherapy.
Retrospective data was collected on Stage III-IV lung cancer patients who received ICIs between 2015 and 2018. All cardiotoxicities associated with ICI were assessed in correlation with the timing of radiotherapy (RT) in relation to ICI, and the mean RT heart dose. The rate of cardiac events in relation to RT timing and heart dose was compared using multiple logistic regression including the Framingham risk score and steroid use prior to ICI therapy.
Of 194 ICI-treated patients evaluated, 55.2% (n=107/194) patients had received thoracic RT at a median dose of 60.4 Gy (range, 15-75). Cardiotoxicities such as non-ST elevated myocardial infarction and new onset supraventricular tachycardias were observed in 13 (12.2%) of those who had thoracic RT versus 9 (10.3%) who did not (p=0.87). 38 patients who received RT concurrently with ICI did not develop any cardiotoxicity whereas 14.1% (n=22/156) of those who did not receive concurrent RT developed cardiotoxicities (univariate, p=0.030; multivariate, p=0.055). There were no significant differences in the mean heart RT dose, Framingham risk score, and steroid treatment between patients that received concurrent RT with ICI versus non-concurrent RT/ICI.
ICI-related cardiotoxicities were not significantly associated with patients who received concurrent thoracic radiotherapy in this retrospective review. Further validation of prospective studies is needed to confirm these results.
免疫检查点抑制剂（ICIs）用于治疗局部晚期和转移性肺癌，这可能导致严重的免疫原性相关心脏毒性。我们评估了接受或未接受胸部放疗心脏照射的ICI治疗肺癌患者的心脏毒性风险。
收集2015年至2018年间接受ICIs治疗的III-IV期肺癌患者的回顾性数据。评估所有与ICI相关的心脏毒性，并与放疗（RT）相对于ICI的时间以及平均RT心脏剂量相关联。使用包括Framingham风险评分和ICI治疗前使用类固醇在内的多元逻辑回归比较与RT时间和心脏剂量相关的心脏事件发生率。
在评估的194例接受ICI治疗的患者中，55.2%（n=107/194）的患者接受了胸部放疗，中位剂量为60.4 Gy（范围，15-75）。接受胸部放疗的患者中有13例（12.2%）出现了非ST段抬高型心肌梗死和新发室上性心动过速等心脏毒性，而未接受胸部放疗的患者中有9例（10.3%）出现了此类情况（p=0.87）。38例在接受ICI治疗的同时接受放疗的患者未出现任何心脏毒性，而未接受同步放疗的患者中有14.1%（n=22/156）出现了心脏毒性（单因素分析，p=0.030；多因素分析，p=0.055）。在接受ICI同步放疗与非同步放疗/ICI的患者之间，平均心脏放疗剂量、Framingham风险评分和类固醇治疗方面没有显著差异。
在这项回顾性研究中，ICI相关心脏毒性与接受同步胸部放疗的患者没有显著关联。需要进一步进行前瞻性研究验证以证实这些结果。
