Salim Hayek, Department Chair of Internal Medicine at The University of Texas Medical Branch, shared on LinkedIn:
“Patients on immune checkpoint inhibitors were 40% more likely than patients on chemotherapy to be hospitalized for a heart attack, stroke or heart failure within two years.
That is the main finding of our new paper in JCO Oncology Practice, led by Aidan Vosooghi.
Checkpoint inhibitors release the immune system’s brakes against cancer.
Cardio-oncology has spent most of its attention on the rare and often fatal myocarditis (inflammation of the heart muscle) they can cause, which affects under 1% of patients. We wanted to know whether the more common, slower harms were also higher than with standard chemotherapy.
We used health records from 102 health care organizations. We matched 15,360 patients starting checkpoint inhibitors for lung, skin, gut or urinary cancers to 15,360 similar patients treated with chemotherapy.
At two years, 5.2% of the checkpoint group had been hospitalized for a major cardiac event, against 3.7% on chemotherapy. That is about one extra hospitalization for every 67 patients treated. The excess showed up for heart failure, heart attack and stroke alike.
The risk was uneven across drugs. Ipilimumab plus nivolumab carried the highest early risk, in the first six months. Durvalumab had the highest two-year cumulative incidence, 16.2%.
The chemotherapy group came from an earlier era, and that is the design’s main limit. The result held across checks for era, timing and radiation.
The practical point is surveillance. Most cardiac monitoring on these drugs is built around catching myocarditis in the first weeks.
The larger burden arrives later, and follow-up should be built to meet it.”
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