Cardiovascular disease and its association with outcomes in cancer patients treated with Immune checkpoint inhibitors

Background: Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, yet responses vary significantly among different populations. Pre-treatment cardiovascular disease (CVD) is recognized as a potential indicator of heightened cardiotoxicity risk; however, data on the outcomes of ICIs therapy in patients presenting with pre-existing CVD remain scarce.

Objective: This study aims to assess the outcomes of ICIs therapy in patients with pre-treatment CVD.

Methods: We conducted a retrospective single-center study including patients diagnosed with cancer and treated with ICIs therapy. Medical records were reviewed for baseline pre-treatment CVD. The primary endpoint was all-cause mortality.

Results: Overall, 2409 patients were included in our cohort, with a mean age of 66±13 years, predominantly male (59%). Lung cancer was the most prevalent diagnosis (23%), and pembrolizumab (anti-PD-1) was the most commonly administered treatment (58%). Baseline CVD at baseline included 375 (16%) patients with ischemic heart disease (IHD), 83 (3%) with heart failure (HF), and 137 (6%) with atrial fibrillation (AF). Multivariate analysis revealed that patients with baseline IHD (HR 1.160 [95% CI = 1.068-1.344], p = 0.049) or HF (HR 1.490 [95% CI = 1.141-1.946], p = 0.003) experienced significantly higher all-cause mortality. There were no significant differences between the groups in AF.

Conclusions: Our findings suggest a potentially detrimental impact of baseline CVD, particularly IHD and HF, on the survival of patients treated with ICIs therapy. Further prospective studies with larger sample sizes are warranted to validate these results.