Abstract 14901: Risk Factors for Cardiotoxicity in Cancer Patients Receiving Immune Checkpoint Inhibitors: A Systematic Review With Meta-Analysis

Abstract

Introduction Although immune checkpoint inhibitors (ICI) have reshaped the treatment landscape for cancer patients, they carry potential risk for the development of cardiovascular adverse events (CVAEs). Objectives We attempted to identify risk factors for CVAEs in cancer patients receiving ICI. Methods Two investigators (C.H.H. and Y.C.) independently reviewed Medline, PubMed, and Embase from inception to May 20, 2022 to identify high quality studies. We included randomized controlled trials, prospective or retrospective cohorts that reported the risks factors for any new onset or worsening CVAEs, including cardiomyopathy, arrhythmia, heart failure, acute coronary syndrome, myocarditis, and pericarditis, in cancer patients receiving ICI. Two investigators (E.A. and M.A.) independently extracted data from included studies. Any discrepancy was resolved through discussion with senior reviewers (K.Y.C and M.N.). We performed random-effects meta-analyses on risk factors for CVAEs after the initiation of ICI. We used I-statistics (I 2 ) to quantify the statistical heterogeneity. Results 12 observational studies involving 21,912 patients (CVAEs=2,897) of any cancers were included for final qualitative and quantitative analyses. 11 covariates, including age, gender, body mass index, ever-smoking history, hypertension, type II diabetes, coronary artery disease (CAD), congestive heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease, and stroke, were available for the meta-analyses. Our meta-analyses (Table 1) demonstrated that male gender, hypertension, CAD, and CKD were associated with increased odds for the development of CVAEs in patients taking ICI. Conclusions In conclusion, male gender, hypertension, CAD, and CKD were identified as significant risk factors for CVAEs in patients taking ICI. Evidence supports a strategy of proper optimization of risk factors before, during, and after the ICI treatment.

Varying presentations of immune checkpoint inhibitor-associated myocarditis: A case report of the clinical characteristics and outcomes of three patients

“…While risk factors for cardiac IRAEs remain to be fully elucidated, two putative risk factors are a history of coronary artery disease and hypertension, both of which the patients in cases 2 and 3 possessed ( Huang et al, 2022 , Jiménez-Alejandre et al, 2022 ). Importantly, patients with even a single IREA have been shown to be at an increased risk for the development of additional systemic toxicities, as was highlighted in case 3 ( Koelzer et al, 2016 ).…”