Cardiac biomarkers in patients with renal cell carcinoma treated with immune checkpoint inhibitors

Area of Science:

• Cardiology
• Oncology
• Clinical Trials

Background:

• Immune checkpoint inhibitors (ICIs) are increasingly used for cancer treatment.
• Cardiac toxicity is a potential concern with ICIs, but evidence for routine cardiac biomarker surveillance is limited.
• The JAVELIN Renal 101 trial provides an opportunity to examine cardiac biomarkers during ICI treatment.

Purpose of the Study:

• To assess the utility of routine cardiac biomarker surveillance during ICI treatment.
• To evaluate baseline cardiac biomarker levels in patients with advanced renal cell carcinoma.
• To investigate the association between cardiac biomarker elevation and major adverse cardiac events (MACE) during ICI therapy.

Main Methods:

• Analysis of cardiac biomarkers (troponin T, troponin I, BNP, NT-proBNP) at baseline and during treatment in the JAVELIN Renal 101 phase 3 trial.
• Comparison of avelumab plus axitinib versus sunitinib treatment arms.
• Assessment of MACE incidence in relation to cardiac biomarker levels.

Main Results:

• A significant proportion of patients had elevated baseline cardiac biomarkers (e.g., 19.8% for troponin T, 32.8% for NT-proBNP).
• Elevated cardiac biomarker levels were observed during treatment in both study arms.
• No clear association was found between cardiac biomarker elevation and MACE, though the number of events was small.

Conclusions:

• High baseline cardiac biomarker levels are common in cancer patients, complicating routine surveillance.
• Routine cardiac biomarker surveillance during ICI treatment requires careful interpretation considering baseline values.
• Further research is needed to establish the role and optimal strategy for cardiac biomarker monitoring in patients receiving ICIs.