Elevations of Cardiac Troponin in Patients Receiving Immune Checkpoint Inhibitors: Data From a Prospective Study

Area of Science:

• Cardiology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) are vital cancer treatments but can cause immune-related adverse events.
• ICI-myocarditis is a serious adverse event, challenging to diagnose due to unclear early symptoms and biomarker roles.
• The significance of high-sensitivity troponin T (hs-TnT) trajectories in ICI-myocarditis diagnosis remains uncertain.

Purpose of the Study:

• To analyze hs-TnT kinetics in cancer patients undergoing ICI therapy.
• To identify predictive biomarkers for ICI-myocarditis development.

Main Methods:

• Prospective, observational, single-center study of 164 patients receiving ICI therapy.
• Collected patient history, demographics, clinical characteristics, and survival data.
• Analyzed associations between elevated hs-TnT (≥14 ng/L) and significant hs-TnT rise (≥28 ng/L) with ICI-myocarditis.

Main Results:

• 16% of patients (26/164) showed significant hs-TnT elevations; 5% (8/164) developed ICI-myocarditis.
• Most ICI-myocarditis cases (69%) were uncertainly diagnosed; 38% lacked cardiac symptoms.
• ICI-myocarditis cases had higher hs-TnT elevations than asymptomatic patients.

Conclusions:

• Significant hs-TnT elevations are more common than previously thought in ICI patients.
• Elevated hs-TnT levels in ICI patients are often asymptomatic and do not invariably signify myocarditis.
• Further research is needed to clarify the diagnostic utility of hs-TnT in ICI-myocarditis.