A retrospective cohort study on the cardiotoxicity incidence rates of immune checkpoint inhibitors for oncology patients

Abstract

Background: This present study investigated the incidence rates of cardiotoxicity among cancer patients treated with immune checkpoint inhibitors (ICIs) plus other anticancer drugs. Methods: 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. Results: 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. Conclusion: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.

Safety and effectiveness of remdesivir in hospitalized patients with COVID-19 and severe renal impairment: experience at a large medical center

“…Furthermore, our study utilized the incidence rate to assess AKI risks, while previous studies relied solely on incidence. The use of both the incidence rate and hazard ratio in our analysis minimizes potential biases when evaluating the risk of drug-related adverse events [ 40 ].…”

Winners of the 2022 honor awards for excellence at the annual meeting of the Chinese Medical Association-Taipei: Part I

“…12,13 The other study entitled "Clinical outcomes and metastatic behavior between de novo versus recurrent HER2-positive metastatic breast cancer: A 17-year single-institution cohort study at Taipei Veterans General Hospital" was conducted by Dr Cheng and her colleagues. 3 Similar to management of all other types of cancers, 2,8,10,11,13 therapy of breast cancer (BC) is usually a multimodality approach, which consists of surgery, radiotherapy, hormone therapy, chemotherapy, immunotherapy, and targeted therapy. Among these, immunotherapy and targeted therapy may offer a new chance to overcome the troublesome BC patients, either advanced-stage or recurrent BC or BC with aggressive behaviors by improving the outcome and prolonging life.…”

“…Besides of the need of multimodality therapy for advanced-stage HNC, these patients have received repeated and repeated therapy with resultant a heavy treatment, which is not only associated with an increased risk of morbidities but also contributes to the development of severe adverse events. 10,11 CBS, referring to the rupture of the carotid artery may be one of the well-known life-threatening complications of HNC after heavy treatment for HNC patients. 2 The therapeutic goal of CBS includes not only life-saving but also recurrence-preventing.…”

Winners of the 2022 honor awards for excellence at the annual meeting of the Chinese Medical Association-Taipei: Part IV

“…1 Immuno-oncology is one of the leading therapeutic advanced therapies for cancer patients, not only due to successful transformation of the treatment landscape but also clear prediction of outcomes with assistance of molecular-pathological findings. [2][3][4][5][6] Dr. Lai and colleagues attempted to evaluate the effectiveness of the anti-epidermal growth factor receptor (EGFR) monoclonal antibody cetuximab for the treatment of HNSCC patients after progression on ICIs. 1 The 28 patients were enrolled with objective response rate (ORR) of 32.1% (95% CI, 17.9%-50.6%) and disease control rate (DCR) of 53.6% (95% CI, 42.4%-6.4%), respectively.…”

“…1 Immuno-oncology is one of the leading therapeutic advanced therapies for cancer patients, not only due to successful transformation of the treatment landscape but also clear prediction of outcomes with assistance of molecular-pathological findings. 2–6…”