Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting
Background: Immune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is uncommon but can be fatal. There have been few reports of iRC from a rural cancer population and few data for iRC and inflammatory biomarkers. Objectives: The purpose of this study was to characterize major adverse cardiac...
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2020-09-01
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doaj-2691baca37014e2b929a2fc8add9b1052020-11-26T13:38:02ZengElsevierJACC. CardioOncology2666-08732020-09-0123491502Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural SettingMelissa Y.Y. Moey, MD, MSc0Anna N. Tomdio, MD1Justin D. McCallen, BSc2Lauren M. Vaughan, MD3Kevin O’Brien, PhD4Abdul R. Naqash, MD5Cynthia Cherry, RN, ANP6Paul R. Walker, MD7Blase A. Carabello, MD8Department of Cardiovascular Sciences, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA; Address for correspondence: Dr. Melissa Y.Y. Moey, East Carolina Heart Institute, 115 Heart Drive, Greenville, North Carolina 27834.Department of Cardiovascular Sciences, Virginia Commonwealth University, Richmond, Virginia, USABrody School of Medicine, East Carolina University, Greenville, North Carolina, USADepartment of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USADepartment of Biostatistics, East Carolina University, Greenville, North Carolina, USADepartment of Hematology and Oncology, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA; U.S. National Institutes of Health, Bethesda, Maryland, USADepartment of Hematology and Oncology, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USADepartment of Hematology and Oncology, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USADepartment of Cardiovascular Sciences, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USABackground: Immune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is uncommon but can be fatal. There have been few reports of iRC from a rural cancer population and few data for iRC and inflammatory biomarkers. Objectives: The purpose of this study was to characterize major adverse cardiac events (MACE) in ICI-treated lung cancer patients based in a rural setting and to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in the diagnosis of iRC. Methods: Patients with lung cancer treated with ICIs at Vidant Medical Center/East Carolina University (VMC/ECU) between 2015 and 2018 were retrospectively identified. MACE included myocarditis, non-ST-segment elevated myocardial infarction (NSTEMI), supraventricular tachycardia (SVT), and pericardial disorders. Medical history, laboratory values, pre-ICI electrocardiography (ECG), and echocardiography results were compared in patients with and without MACE. Results: Among 196 ICI-treated patients, 23 patients (11%) developed MACE at a median of 46 days from the first ICI infusion (interquartile range [IQR]: 17 to 83 days). Patients who developed MACE experienced myocarditis (n = 9), NSTEMI (n = 3), SVT (n = 7), and pericardial disorders (n = 4). Ejection fraction was not significantly different at the time of MACE compared to that at baseline (p = 0.495). Compared to baseline values, NLR (10.9 ± 8.3 vs. 20.7 ± 4.2, respectively; p = 0.032) and CRP (42.1 ± 10.1 mg/l vs. 109.9 ± 15.6 mg/l, respectively; p = 0.010) were significantly elevated at the time of MACE. Conclusions: NLR and CRP were significantly elevated at the time of MACE compared to baseline values in ICI-treated patients. Larger datasets are needed to validate these findings and identify predictors of MACE that can be used in the diagnosis and management of ICI-related iRC.http://www.sciencedirect.com/science/article/pii/S2666087320301678immune checkpoint inhibitorsinflammatory markersmyocarditisneutrophil-to-lymphocyte ratio |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Melissa Y.Y. Moey, MD, MSc Anna N. Tomdio, MD Justin D. McCallen, BSc Lauren M. Vaughan, MD Kevin O’Brien, PhD Abdul R. Naqash, MD Cynthia Cherry, RN, ANP Paul R. Walker, MD Blase A. Carabello, MD |
spellingShingle |
Melissa Y.Y. Moey, MD, MSc Anna N. Tomdio, MD Justin D. McCallen, BSc Lauren M. Vaughan, MD Kevin O’Brien, PhD Abdul R. Naqash, MD Cynthia Cherry, RN, ANP Paul R. Walker, MD Blase A. Carabello, MD Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting JACC. CardioOncology immune checkpoint inhibitors inflammatory markers myocarditis neutrophil-to-lymphocyte ratio |
author_facet |
Melissa Y.Y. Moey, MD, MSc Anna N. Tomdio, MD Justin D. McCallen, BSc Lauren M. Vaughan, MD Kevin O’Brien, PhD Abdul R. Naqash, MD Cynthia Cherry, RN, ANP Paul R. Walker, MD Blase A. Carabello, MD |
author_sort |
Melissa Y.Y. Moey, MD, MSc |
title |
Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting |
title_short |
Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting |
title_full |
Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting |
title_fullStr |
Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting |
title_full_unstemmed |
Characterization of Immune Checkpoint Inhibitor-Related Cardiotoxicity in Lung Cancer Patients From a Rural Setting |
title_sort |
characterization of immune checkpoint inhibitor-related cardiotoxicity in lung cancer patients from a rural setting |
publisher |
Elsevier |
series |
JACC. CardioOncology |
issn |
2666-0873 |
publishDate |
2020-09-01 |
description |
Background: Immune checkpoint inhibitor (ICI)-related cardiotoxicity (iRC) is uncommon but can be fatal. There have been few reports of iRC from a rural cancer population and few data for iRC and inflammatory biomarkers. Objectives: The purpose of this study was to characterize major adverse cardiac events (MACE) in ICI-treated lung cancer patients based in a rural setting and to assess the utility of C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) in the diagnosis of iRC. Methods: Patients with lung cancer treated with ICIs at Vidant Medical Center/East Carolina University (VMC/ECU) between 2015 and 2018 were retrospectively identified. MACE included myocarditis, non-ST-segment elevated myocardial infarction (NSTEMI), supraventricular tachycardia (SVT), and pericardial disorders. Medical history, laboratory values, pre-ICI electrocardiography (ECG), and echocardiography results were compared in patients with and without MACE. Results: Among 196 ICI-treated patients, 23 patients (11%) developed MACE at a median of 46 days from the first ICI infusion (interquartile range [IQR]: 17 to 83 days). Patients who developed MACE experienced myocarditis (n = 9), NSTEMI (n = 3), SVT (n = 7), and pericardial disorders (n = 4). Ejection fraction was not significantly different at the time of MACE compared to that at baseline (p = 0.495). Compared to baseline values, NLR (10.9 ± 8.3 vs. 20.7 ± 4.2, respectively; p = 0.032) and CRP (42.1 ± 10.1 mg/l vs. 109.9 ± 15.6 mg/l, respectively; p = 0.010) were significantly elevated at the time of MACE. Conclusions: NLR and CRP were significantly elevated at the time of MACE compared to baseline values in ICI-treated patients. Larger datasets are needed to validate these findings and identify predictors of MACE that can be used in the diagnosis and management of ICI-related iRC. |
topic |
immune checkpoint inhibitors inflammatory markers myocarditis neutrophil-to-lymphocyte ratio |
url |
http://www.sciencedirect.com/science/article/pii/S2666087320301678 |
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