Troponin Screening and Major Cardiovascular Adverse Events During Immune Checkpoint Inhibitor Therapy

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Immune checkpoint inhibitors (ICIs) are increasingly used for cancer treatment.
• Troponin monitoring is recommended for detecting ICI-associated myocarditis.
• The utility of troponin as a universal screening tool for all cardiovascular toxic effects of ICIs is uncertain.

Purpose of the Study:

• To evaluate if systematic troponin screening reduces major adverse cardiovascular events (MACEs) and mortality in cancer patients receiving ICI therapy.

Main Methods:

• Retrospective, multicenter cohort study of adults treated with ICIs for solid cancer.
• Comparison of patients undergoing systematic troponin screening versus clinical assessment without screening.
• Analysis using multivariate Cox regression, competing risk models, and propensity score matching.

Main Results:

• Routine troponin screening was associated with lower combined MACEs and mortality in multivariable models (HR, 0.56).
• However, screening was not associated with reduced MACEs after competing risk analysis (HR, 0.56) or in propensity score-matched cohorts (HR, 0.49).
• The majority of deaths were cancer-related, not cardiovascular.

Conclusions:

• Systematic troponin screening was not associated with reduced MACEs in unselected older patients with metastatic solid cancer receiving ICIs.
• The benefits of universal troponin monitoring in this population are questionable.
• Risk-adapted screening strategies may be necessary to improve outcomes and avoid treatment interruptions.