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Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting
Melissa Y Y Moey1, Anna N Tomdio2, Justin D McCallen3
1Department of Cardiovascular Sciences, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA.
JACC. Cardiooncology
|August 16, 2021
Summary
Immune checkpoint inhibitor (ICI) cardiotoxicity is rare but serious. This study found elevated C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in lung cancer patients experiencing major adverse cardiac events (MACE) during ICI therapy.
Area of Science:
- Cardiology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is an uncommon but potentially fatal complication.
- Limited data exist on iRC in rural cancer populations and its association with inflammatory biomarkers.
Purpose of the Study:
- To characterize major adverse cardiac events (MACE) in rural lung cancer patients treated with ICIs.
- To evaluate the diagnostic utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) for iRC.
Main Methods:
- Retrospective analysis of lung cancer patients treated with ICIs from 2015-2018.
- Defined MACE as myocarditis, NSTEMI, SVT, or pericardial disorders.
- Compared baseline and MACE-associated laboratory values, ECG, and echocardiography.
Main Results:
- 11% (23/196) of ICI-treated patients developed MACE at a median of 46 days.
- MACE included myocarditis, NSTEMI, SVT, and pericardial disorders.
- Significantly elevated NLR and CRP levels were observed at the time of MACE compared to baseline.
Conclusions:
- NLR and CRP levels were significantly elevated during MACE in ICI-treated patients.
- Further research with larger cohorts is necessary to validate these findings.
- Identifying predictors of MACE is crucial for managing iRC.
Keywords:
CAR T, chimeric antigen receptor T cellCTCAE, common terminology for clinical adverse eventsCTLA-4, cytotoxicity T-cell lymphocyte antigenICI, immune checkpoint inhibitorMACE, major adverse cardiac eventsNLR, neutrophil-to-lymphocyte ratioNSCLC, non-small cell lung cancerPD, programmed cell deathPD-L1, programmed cell death-ligand 1iRC, immune checkpoint inhibitor-related cardiotoxicityimmune checkpoint inhibitorsinflammatory markersirAE, immune-related adverse eventsmyocarditisneutrophil-to-lymphocyte ratioRelated Concept Videos
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