THE IMPACT OF ROUTINE CARDIAC TROPONIN I-BASED CARDIOTOXICITY SCREENING ON CLINICAL OUTCOMES IN PATIENTS ON CANCER...

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICI) can cause severe cardiac immune-related adverse events (irAEs), including fatal myocarditis.
• Early detection via cardiotoxicity screening and biomarker monitoring can improve patient outcomes.
• This study evaluates the impact of troponin I monitoring on cardiovascular adverse events (CV AEs) and overall survival (OS) in asymptomatic patients receiving ICI.

Approach:

• A standardized troponin I screening protocol was implemented for patients receiving ICI.
• Data from 825 patients (428 monitored, 397 unmonitored) treated between January 2018 and October 2021 were analyzed.
• Outcomes including CV AEs, all-cause mortality, and oncologic time-to-treatment failure (TTF) were compared between monitored and unmonitored groups.

Key Points:

• Patients undergoing troponin monitoring had a significantly lower rate of severe (grades 4-5) CV AEs (0.5% vs. 1.8%).
• Troponin I elevation was strongly associated with increased CV AEs and mortality in all patients.
• No significant difference in overall CV AEs, OS, or TTF was observed between monitored and unmonitored groups.

Conclusions:

• Cardiotoxicity screening with troponin I monitoring is associated with a reduced incidence of severe CV AEs in patients receiving ICI.
• Elevated troponin I levels serve as a critical predictor of adverse cardiovascular events and mortality.
• Troponin I monitoring shows preliminary clinical utility for managing cardiotoxicity in ICI-treated cancer patients.