Real-Life Management of Elevated Troponin Level in Patients Treated with Immune Checkpoint Inhibitors

Area of Science:

• Cardio-oncology
• Immunotherapy
• Cardiac Biomarkers

Background:

• Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but can cause myocardial injury.
• Current guidelines lack specific protocols for managing elevated troponin levels during ICI therapy.
• Routine troponin monitoring is recommended, but clinical assessment and management strategies vary.

Purpose of the Study:

• To describe the real-life assessment and management of patients treated with ICIs who presented with elevated high-sensitivity troponin I (hs-TnI) levels.
• To evaluate the clinical outcomes and interventions in patients with ICI-associated myocardial injury.

Main Methods:

• Retrospective analysis of patients undergoing routine hs-TnI monitoring during ICI therapy at Tel Aviv Sourasky Medical Center.
• Evaluation of clinical data, including electrocardiograms, echocardiography, cardiology consultations, and treatment decisions for patients with hs-TnI > 50 ng/L.

Main Results:

• 11% of patients (50/455) showed elevated hs-TnI levels post-ICI therapy (median 159 ng/L).
• 10% had electrocardiogram changes; 8% had echocardiography abnormalities.
• 26% were diagnosed with probable/possible myocarditis, leading to corticosteroid therapy (84%) and ICI discontinuation (92%).

Conclusions:

• This study describes the management of elevated hs-TnI levels during routine ICI surveillance.
• Significant diversity in management, limited cardiology consultation, and high rates of therapy interruption were observed.
• Standardized management guidelines are needed for elevated hs-TnI levels in patients receiving ICI therapy.