Clinical implications of isolated troponinemia following immune checkpoint inhibitor therapy

Delombaerde, Danielle; Vervloet, Delphine; Franssen, Constantijn; Croes, Lieselot; Gremonprez, Félix; Prenen, Hans; Peeters, Marc; Vulsteke, Christof

doi:10.1016/j.esmoop.2021.100216

Cited by 26 publications

(22 citation statements)

References 78 publications

(162 reference statements)

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“…However, even in this setting, a universal agreement on how to precisely make use of them into routine clinical practice has not been reached yet [1]. Similar difficulties in establishing the exact potential diagnostic and predictive role of cardiac biomarkers also emerged in relation to cardiotoxicity due to immune checkpoint inhibitors (ICIs) and radiotherapy [2,3].…”

Section: Cardiac Biomarkers Phatophysiologymentioning

confidence: 99%

“…Research focused on the ability of the same markers to predict, if dosed at baseline, or early detect, if dosed serially during chemotherapy, myocarditis at the onset. Among the few clinical trials regarding the predictive ability of baseline troponin measurement for subsequent myocarditis after ICIs initiation, none proved a good positive predictive value or good specificity of the biomarker [3].…”

Section: Myocarditis Due To Immune Check Points Inhibitorsmentioning

confidence: 99%

“…The serial measurement of troponin during ICIs courses has also been proposed in routine clinical practice [51], but the clinical usefulness of a biomarker-based screening for ICIs-related myocarditis has not yet been proved [3]. To be useful, this approach should lead to the early diagnosis of myocarditis without resulting in the unnecessary suspension of cancer therapy.…”

Section: Myocarditis Due To Immune Check Points Inhibitorsmentioning

confidence: 99%

“…This is the largest prospective study carried out so far on the topic. Other few studies were carried out, but they were weak in methodology and had a too small population to find significant results [3].…”

Section: Myocarditis Due To Immune Check Points Inhibitorsmentioning

confidence: 99%

“…Similar difficulties in establishing the exact potential diagnostic and predictive role of cardiac biomarkers also emerged in relation to cardiotoxicity due to immune checkpoint inhibitors (ICIs) and radiotherapy [2,3].…”

Section: Introductionmentioning

confidence: 98%

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Role of Cardiac Biomarkers in Cancer Patients

Semeraro

Cipolla

Cardinale

2021

Cancers

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In patients with cancer—and especially some specific subtypes—the heart can be pathologically affected due to the direct action of the tumor or its secretion products or due to the toxicity of some oncological treatments. Cardiac biomarkers have been investigated as inexpensive and easily accessible tools for prediction, early diagnosis, monitoring, or prognosis of various forms of cancer-related cardiac diseases. However, their clinical usefulness was not always clearly demonstrated in every area of cardioncology. For the identification of anthracycline related cardiotoxicity in the very early stages troponins proved to be more efficient detectors than imaging methods. Nevertheless, the lack of a standardized dosage methodology and of cardiotoxicity specific thresholds, do not yet allow to outline the precise way to employ them in clinical routine and to incorporate them into appropriate diagnostic or managing algorithms. Cardiac biomarkers proved also effective in patients with primary cardiac amyloidosis, in which both troponins and natriuretic peptides were able to predict adverse outcome, and carcinoid heart disease, where a precise diagnostic cut-off for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was identified to screen patients with valvular involvement. Likewise, NT-proBNP proved to be an excellent predictor of postoperative atrial fibrillation (POAF). On the contrary, evidence is still not sufficient to promote the routine use of cardiac biomarkers to early diagnose myocarditis due to immune check points inhibitors (ICIs), radiotherapy induced cardiotoxicity and cardiac complications related to androgenetic deprivation. In this review we present all the evidence gathered so far regarding the usefulness and limitations of these relatively inexpensive diagnostic tools in the field of cardio-oncology.

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Section: Cardiac Biomarkers Phatophysiologymentioning

confidence: 99%

Section: Myocarditis Due To Immune Check Points Inhibitorsmentioning

confidence: 99%

Section: Myocarditis Due To Immune Check Points Inhibitorsmentioning

confidence: 99%

Section: Myocarditis Due To Immune Check Points Inhibitorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Role of Cardiac Biomarkers in Cancer Patients

Semeraro

Cipolla

Cardinale

2021

Cancers

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Preclinical models of cardiotoxicity from immune checkpoint inhibitor therapy

Buehning,

Lerchner,

Vogel

et al. 2024

Basic Res Cardiol

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Immune checkpoint inhibitor (ICI) therapy represents a ground-breaking paradigm in cancer treatment, harnessing the immune system to combat malignancies by targeting checkpoints such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1). The use of ICI therapy generates distinctive immune-related adverse events (irAEs) including cardiovascular toxicity, necessitating targeted research efforts. This comprehensive review explores preclinical models dedicated to ICI-mediated cardiovascular complications including myocarditis. Tailored preclinical models of ICI-mediated myocardial toxicities highlight the key role of CD8+ T cells, emphasizing the profound impact of immune checkpoints on maintaining cardiac integrity. Cytokines and macrophages were identified as possible driving factors in disease progression, and at the same time, initial data on possible cardiac antigens responsible are emerging. The implications of contributing factors including thoracic radiation, autoimmune disorder, and the presence of cancer itself are increasingly understood. Besides myocarditis, mouse models unveiled an accelerated progression of atherosclerosis, adding another layer for a thorough understanding of the diverse processes involving cardiovascular immune checkpoint signalling. This review aims to discuss current preclinical models of ICI cardiotoxicity and their potential for improving enhanced risk assessment and diagnostics, offering potential targets for innovative cardioprotective strategies. Lessons from ICI therapy can drive novel approaches in cardiovascular research, extending insights to areas such as myocardial infarction and heart failure.

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Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies

Bergler‐Klein

Rainer

Wallner

et al. 2022

Wien Klin Wochenschr

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SummarySurvival in cancer is continuously improving due to evolving oncological treatment. Therefore, cardiovascular short-term and long-term side effects gain crucial importance for overall outcome. Cardiotoxicity not only presents as heart failure, but also as treatment-resistant hypertension, acute coronary ischemia with plaque rupture or vasospasm, thromboembolism, arrhythmia, pulmonary hypertension, diastolic dysfunction, acute myocarditis and others. Recent recommendations have proposed baseline cardiac risk assessment and surveillance strategies. Major challenges are the availability of monitoring and imaging resources, including echocardiography with speckle tracking longitudinal strain (GLS), serum biomarkers such as natriuretic peptides (NT-proBNP) and highly sensitive cardiac troponins. This Austrian consensus encompasses cardiotoxicity occurrence in frequent antiproliferative cancer drugs, radiotherapy, immune checkpoint inhibitors and cardiac follow-up considerations in cancer survivors in the context of the Austrian healthcare setting. It is important to optimize cardiovascular risk factors and pre-existing cardiac diseases without delaying oncological treatment. If left ventricular ejection fraction (LVEF) deteriorates during cancer treatment (from >10% to <50%), or myocardial strain decreases (>15% change in GLS), early initiation of cardioprotective therapies (angiotensin-converting enzyme inhibitors, angiotensin or beta receptor blockers) is recommended, and LVEF should be reassessed before discontinuation. Lower LVEF cut-offs were recently shown to be feasible in breast cancer patients to enable optimal anticancer treatment. Interdisciplinary cardio-oncology cooperation is pivotal for optimal management of cancer patients.

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Clinical implications of isolated troponinemia following immune checkpoint inhibitor therapy

Cited by 26 publications

References 78 publications

Role of Cardiac Biomarkers in Cancer Patients

Role of Cardiac Biomarkers in Cancer Patients

Preclinical models of cardiotoxicity from immune checkpoint inhibitor therapy

Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies

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