Real-world cardiac evaluation in patients with advanced lung cancer who received immune checkpoint inhibitors.

Abstract

e23360 Background: Cardiac toxicities have been increasingly recognized with the widespread use of cancer immunotherapy. Recent NCCN guideline V1.2025 on Immunotherapy-Related Adverse Events (irAEs) recommends considering baseline electrocardiogram (ECG), high-sensitivity troponin and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) for the indetification of those at increased risk, and periodic testing for those with abnormal baseline or symptoms after starting immunotherapy. However, the recommendation was mostly based on the expert opinions. We conducted a real-world analysis on the cardiac evaluation in patients with advanced lung cancer during immune checkpoint inhibitors (ICIs) treatment at our institution. Methods: We analyzed the use of ECG, echocardiogram, troponin and NT-proBNP in 399 lung cancer patients who received ICIs through the pharmacy records between October 2014 to December 2023 at our institution. Abnormal cardiac functions were defined as left ventricular ejection fraction (LVEF) < 50%, or prolonged QTc interval ≥500 ms, or abnormal blood cardiac biomarkers (troponin T or NT-proBNP). The clinical significance of these cardiac irAEs were determined by the association with median overall survival (mOS) between death date and first date of ICI. Results: We found the clinical use of these 4 tests varies significantly: ECG 89.7%, Echo 70.2%, Troponin 64.4%, and NT-proBNP 16.0%. Abnormality rate of these tests were found with ECG 77 pts (21.5%), echo 49 pts (17.5%), troponin 149 pts (28.0%), and NT-proBNP 54 (84.4%), respectively. Patients with LVEF < 50% was associated with poor mOS (3.9 vs 6.8 months). The combination of EKG and NT-proBNP had the best association with OS (p = 0.009), followed by the combination of EKG and Troponin (p = 0.03), and nBNP (p = 0.01). Long-term follow-up for chronic cardiovascular complications in the survivors received ICI therapy is ongoing. Conclusions: Prospective validation is needed for the multidisciplinary, quantitative risk assessment for early detection and mitigation of cardiac irAEs during and after ICI treatment.