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T-cell engager (TCE) therapy has a generally favorable cardiovascular safety profile, but complications increase mortality risk. Patients with coronary artery disease or high-grade cytokine-release syndrome (CRS) and/or immune effector cell-associated neurotoxicity syndrome (ICANS) need closer monitoring.

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Area of Science:

  • Oncology
  • Cardiology
  • Immunotherapy

Background:

  • Cancer immunotherapies, including T-cell engagers (TCEs), are associated with cardiovascular risks.
  • Limited data exist on cardiovascular complications specifically linked to TCE therapy.

Purpose of the Study:

  • To determine the incidence of cardiovascular events (CVEs) during TCE therapy.
  • To identify factors associated with CVEs and mortality in patients receiving TCEs.

Main Methods:

  • Retrospective dual-center study of 567 patients treated with TCEs (2016-2024).
  • Analysis of on-treatment CVEs (heart failure, arrhythmias, myocardial infarction, stroke) and cardiovascular mortality.
  • Used competing-risks models for CVEs and Cox models for all-cause mortality, incorporating time-dependent CRS and ICANS.

Main Results:

  • Overall CVE cumulative incidence was 10.4%, with new left ventricular dysfunction and atrial fibrillation being most common.
  • Cardiovascular mortality was low (0.4%).
  • Preexisting coronary artery disease and development of high-grade CRS/ICANS were associated with increased CVE risk and all-cause mortality.

Conclusions:

  • TCE therapy exhibits an overall favorable cardiovascular safety profile.
  • Cardiovascular complications during TCE therapy significantly increase mortality risk.
  • Patients with coronary artery disease or high-grade CRS/ICANS require intensified cardiovascular monitoring.