Cardiac surveillance in immune checkpoint inhibitor therapy: Insights from the Essen Cardio-oncology Registry

Immune checkpoint inhibitors (ICI) have revolutionized cancer therapy, offering improvements in survival across various malignancies. However, their toxicities pose a major challenge for cardio-oncology units. Despite their growing importance, data on effectiveness of such specialized units in mitigating ICI-associated cardiovascular complications remain scarce.

We analysed 539 cancer patients under ICI therapy from the Essen Cardio-oncology Registry (EcoR). Patients were stratified by enrolment period (2018-2020 vs. 2021-2023), with cancer therapy-related cardiovascular toxicity (CTR-CVT) and overall survival evaluated during follow-up. This included myocarditis, vascular toxicity, cancer therapy-related cardiac dysfunction (CTRCD), arrhythmia and arterial hypertension. CTRCD ranges from elevated cardiac biomarkers, declined cardiac function to decompensated heart failure. Arrhythmia included sinus bradycardia or tachycardia atrial fibrillation and QTc prolongation. Median follow-up time was 486 days.

Patients enrolled between 2021 and 2023 showed higher incidence of myocarditis (odds ratio [OR]: 2.64; 95% confidence interval [CI]: 1.10-6.36; P = 0.03), sinus bradycardia (OR: 5.50; 95% CI: 1.22-24.80; P = 0.03) and atrial fibrillation (OR: 2.23; 95% CI: 1.16-4.28; P = 0.02). This was associated with higher rates of combined ICI therapy and improved overall survival. Conversely, vascular toxicity was significantly reduced (OR 0.05; 95% CI: 0.01-0.40; P = 0.004), paralleling greater statin utilization (14.5% vs. 23.6%; P = 0.008).

The observed association between statin use and reduced vascular toxicity suggests a potential protective strategy in this high-risk population, warranting further investigation in prospective studies.