Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
College of Pharmacy, Taipei Medical University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2023 May 1;86(5):499-505. doi: 10.1097/JCMA.0000000000000910. Epub 2023 Mar 6.
This present study investigated the incidence rates of cardiotoxicity among cancer patients treated with immune checkpoint inhibitors (ICIs) plus other anticancer drugs.
This was a retrospective hospital-based cohort study using the medical records and the Cancer Registry records from the Taipei Veterans General Hospital. We enrolled patients diagnosed with cancer between 2011 and 2017, who were over 20 years old and had received ICI therapy, including pembrolizumab, nivolumab, atezolizumab, and ipilimumab. Cardiotoxicity was defined by the diagnosis of myocarditis, pericarditis, arrhythmia, heart failure, and Takotsubo syndrome.
We identified 407 patients who were eligible to participate in this study. We defined the three treatment groups as follows: ICI therapy, ICI combined with chemotherapy, and ICI combined with targeted therapy. Using ICI therapy as a reference group, the cardiotoxicity risk was not significantly higher compared to the ICI combined with chemotherapy group (adjusted hazard ratio 2.1, 95% confidence interval 0.2-21.1, p = 0.528] or to the ICI combined with targeted therapy group (adjusted hazard ratio 1.2, 95% confidence interval 0.1-9.2, p = 0.883). The total incidence rate of cardiotoxicity was 3.6 of 100 person-years, indicating an average incidence time of 1.0 ± 1.3 years (median: 0.5 years; range: 0.1-4.7 years) for 18 cardiotoxicity patients.
The incidence rate of ICI-related cardiotoxicity is low. Combination of ICI with either chemotherapy or targeted therapy might not significantly increase the risk of cardiotoxicities among cancer patients. Nevertheless, it is recommend being careful in patients treated high-risk cardiotoxicity medications to avoid drug-related cardiotoxicity with a combination of ICI therapy.
本研究旨在调查接受免疫检查点抑制剂（ICI）联合其他抗癌药物治疗的癌症患者发生心脏毒性的发生率。
这是一项回顾性基于医院的队列研究，使用了台北荣民总医院的病历和癌症登记记录。我们纳入了 2011 年至 2017 年间诊断为癌症的患者，年龄超过 20 岁，并接受了 ICI 治疗，包括 pembrolizumab、nivolumab、atezolizumab 和 ipilimumab。心脏毒性的定义为心肌炎、心包炎、心律失常、心力衰竭和 Takotsubo 综合征的诊断。
我们确定了 407 名符合条件的患者参与了这项研究。我们将三组治疗定义如下：ICI 治疗、ICI 联合化疗和 ICI 联合靶向治疗。以 ICI 治疗为参考组，与 ICI 联合化疗组（调整后的危险比 2.1，95%置信区间 0.2-21.1，p=0.528）或 ICI 联合靶向治疗组（调整后的危险比 1.2，95%置信区间 0.1-9.2，p=0.883）相比，心脏毒性的风险没有显著增加。心脏毒性的总发生率为每 100 人年 3.6 例，18 例心脏毒性患者的平均发病时间为 1.0±1.3 年（中位数：0.5 年；范围：0.1-4.7 年）。
ICI 相关心脏毒性的发生率较低。ICI 联合化疗或靶向治疗可能不会显著增加癌症患者心脏毒性的风险。然而，建议在接受高风险心脏毒性药物治疗的患者中谨慎使用，以避免与 ICI 治疗联合使用药物相关的心脏毒性。
