SPC365

Cardiotoxicity Associated with Immune Checkpoint Inhibitors: Myth or Reality?

Session: SESSÃO DE POSTERS 56 - CARDIONCOLOGIA DE PONTA I
Speaker: Nuno Alexandre Dias Madruga

Congress: CPC 2025
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.6 Cardio-Oncology
Session Type: Cartazes
FP Number: ---
Authors: Nuno Madruga; Miguel Nobre Menezes; Catarina Gregório; Miguel Azaredo Raposo; Ana Abrantes; Daniel Cazeiro; João Mendes Cravo; Marta Vilela; Inês Caldeira Araújo; Catarina Sena da Silva; Fausto J. Pinto; Manuela Fiúza

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Cardiotoxicity associated with immune checkpoint inhibitors (ICIs) has become a significant concern in cancer treatment. While ICIs have been effective in improving survival rates, their use has been linked to various cardiovascular side effects, such as myocarditis, arrhythmias, and heart failure, which can be potentially fatal.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To describe the cardiotoxic events in patients treated with ICIs and to identify the associated risk factors.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Retrospective, single-center study at a tertiary hospital involving patients who initiated ICI (ipilimumab, pembrolizumab, nivolumab, cemiplimab, avelumab) between 2021 and 2024, followed in the Oncology consultation. Demographic, laboratory, and echocardiographic data were collected for patients who experienced a cardiotoxicity event</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Among 329 patients treated with ICIs, 10 (3%) experienced a cardiotoxicity event (4 males, mean age 71.9 &plusmn; 11.5 years). Regarding comorbidities, 60% had hypertension, 20% were diabetic, 80% were non-smokers, and 40% had a history of ischemic heart disease. Prior therapies included ACE inhibitors/ARBs and beta-blockers (70%), SGLT2 inhibitors (20%), and statins (30%), with 60% of patients on two or more medications. The most frequent malignancies were renal cell carcinoma (40%), melanoma (40%), and lung adenocarcinoma (20%). 4 patients were treated with nivolumab, 2 with ipilimumab, and 2 with pembrolizumab. Only 2 patients had been previously exposed to cardiotoxic therapies (anthracyclines).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Cardiotoxicity events included 3 cases of acute coronary syndrome (2 in nivolumab), 2 cases of severe myocarditis, and 2 cases of new-onset heart failure, resulting in 7 cardiovascular-related hospitalizations. No arrhythmic events were reported. Forty percent of the patients had been referred to a cardio-oncology consultation prior to the event due to high/very high cardiotoxicity risk, 30% were referred during the event. No arrhythmic events were reported. Forty percent of the patients had been referred to a cardio-oncology consultation prior to the event due to high/very high cardiotoxicity risk, 30% were referred during the event. No reduction in LVEF occurred during follow-up. In both patients with acute myocarditis, intravenous corticosteroids were initiated. One patient with heart failure and both patients with myocarditis discontinued ICI therapy permanently. In a time-to-event analysis, the median time to cardiotoxicity was 94.5 days after initiating the drug (IQR: 38.3&ndash;267.8). Three patients died during follow-up, none from cardiovascular causes.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Cardiotoxicity associated with ICIs, though infrequent, is a clinically significant complication. Patients with a prior risk for cardiotoxicity or evidence of events should be referred to a cardio-oncology consultation to improve outcomes</span></span></span></p>