Cardiac Immune-Related Adverse Events in Immune Checkpoint Inhibition Therapy

Brumbaugh, Aaron D.; Narurkar, Roshni; Parikh, Kaushal; Fanucchi, Michael; Frishman, William H.

doi:10.1097/crd.0000000000000217

Cited by 21 publications

(14 citation statements)

References 79 publications

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“…Immune-related myocarditis is a rare but relatively fatal irAE that manifests as increased troponin, creatine kinase, and BNP [40]. The incidence in this study was 3.5%, one patient developed myocarditis after two cycles of treatment with camrelizumab, and troponin continued to increase.…”

Section: Discussionmentioning

confidence: 54%

Real-world Data Analysis of Immunotherapy in Advanced Lung Cancer

Sun

et al. 2021

Preprint

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BackgroundThis study was designed to investigate the clinical application, efficacy, and safety of immune checkpoint inhibitors (ICIs) in the treatment of lung cancer in the real world. MethodsA retrospective, observational analysis was conducted on patients treated with ICIs in four tertiary hospitals in the region from January 2015 to March 2021, to evaluate the clinical efficacy of ICI single-agent or combined chemotherapy and anti-vascular drugs in the first-line or second-line treatment of patients with advanced lung cancer. ResultsThree hundred and fifteen patients were enrolled in this study. The objective response rate (ORR) and disease control rate (DCR) were 36.5% (115/315) and 94.0% (296/315), respectively, the median progression-free survival (PFS) was 10.8 months, and the median overall survival (OS) was not reached. A total of 165 patients received ICI as the first-line treatment, the median treatment cycle was 8 cycles (2-20 cycles), the short-term efficacy ORR was 41.2%, DCR was 94.5%, and the median PFS was 12.0 months. 150 patients received ICI treatment as second-line treatment, the median treatment cycle was five cycles (2-10 cycles), the short-term efficacy ORR was 31.3%, DCR was 93.3%, and the median PFS was 10.0 months. There were no statistically significant differences in ORR, DCR, or median PFS with ICI as the first-line treatment compared with the second-line treatment(P>0.05). The results of subgroup analysis showed that Karnofsky performance status (KPS) score, EGFR mutation status, and number of treatment lines were not correlated with median PFS((P>0.05). However, there were statistically significant differences in programmed death-ligand 1(PD-L1) expression, pathological types, hormone interference, and antibiotic (Abx) treatment among all groups (P< 0.05). In terms of safety, the overall incidence of adverse reactions in 315 patients was 62.5%, and the incidence of immune-related adverse events(irAEs) was 13.7%. Grade 1-2 and 3-4 incidence of adverse events were 34.9% and 27.65%, respectively. There were four patients who experienced fatal irAEs, two cases were liver damage leading to liver failure, one case was immune related pneumonia, and one case was immune related myocarditis. ConclusionIn the real world, immunotherapy has a good effect on patients with advanced lung cancer and significantly improves ORR and PFS.

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Section: Discussionmentioning

confidence: 54%

Real-world Data Analysis of Immunotherapy in Advanced Lung Cancer

Sun

et al. 2021

Preprint

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“…Re-examination of chest Computed Tomography (CT) revealed pneumonia, combined with multiple serous effusions and gastrointestinal hemorrhage, although he was given ventilator support and anti-infection, corticosteroid and symptomatic treatment and eventually died of severe lung infection and respiratory failure. Immune-related myocarditis is a rare but relatively fatal irAE that manifests as increased troponin, creatine kinase, and brain natriuretic peptide (BNP) [ 31 ]. The incidence in this study was 3.5%, one patient developed myocarditis after two cycles of treatment with camrelizumab, and troponin continued to increase.…”

Section: Discussionmentioning

confidence: 99%

Real-world data analysis of immune checkpoint inhibitors in stage III-IV adenocarcinoma and squamous cell carcinoma

Sun

et al. 2022

BMC Cancer

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Background This study was designed to investigate the clinical application, efficacy, and safety of immune checkpoint inhibitors (ICIs) in the treatment of lung cancer in the real world. Methods A retrospective, observational analysis was conducted on patients treated with ICIs in four tertiary hospitals in the region from January 2015 to March 2021, to evaluate the clinical efficacy of ICIs single-agent or combined chemotherapy and anti-vascular drugs in the first-line or second-line treatment of patients with lung cancer. Results Three hundred and fifteen patients were enrolled in this study. In patients with stage III-IV adenocarcinoma and Squamous cell carcinoma, the objective response rate (ORR) and disease control rate (DCR) were 35.5% (87/245) and 93.5% (229/245), respectively, the median progression-free survival (PFS) was 10.8 months, and the median overall survival (OS) was not reached. A total of 132 patients received ICIs as the first-line treatment, the median treatment cycle was 8 cycles (2–20 cycles), the short-term efficacy ORR was 38.6%, DCR was 93.9%, and the median PFS was 11.4 months. One hundred thirteen patients received ICIs treatment as second-line treatment, the median treatment cycle was five cycles (2–10 cycles), the short-term efficacy ORR was 31.9%, DCR was 92.9%, and the median PFS was 10.0 months. There were no statistically significant differences in ORR, DCR, or median PFS with ICIs as the first-line treatment compared with the second-line treatment(P > 0.05). The results of subgroup analysis showed that Eastern Cooperative Oncology Group performance status (ECOG PS), epidermal growth factor receptor (EGFR) mutation status, pathological type and number of treatment lines were not correlated with median PFS(P > 0.05). However, there were statistically significant differences in programmed death-ligand 1(PD-L1) expression, corticosteroid interference, and antibiotic (Abx) treatment among all groups (P < 0.05). In terms of safety, the overall incidence of adverse reactions in 315 patients was 62.5%, and the incidence of immune-related adverse events (irAEs) was 13.7%. Grade 1–2 and 3–4 incidence of adverse events were 34.9 and 27.65%, respectively. There were four patients who experienced fatal irAEs, two cases were liver damage leading to liver failure, one case was immune related pneumonia, and one case was immune related myocarditis. Conclusion In the real world, ICIs has a good effect on patients with lung cancer and significantly improves ORR and PFS.

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“…irAEs affecting the cardiovascular system have an incidence < 1%, usually occur within the first month of treatment and include myocarditis, arrhythmias, pericarditis, and impaired ventricular function [133,145].…”

Section: Immune-related Adverse Events To Immunotherapymentioning

confidence: 99%

Immunotherapy in the Treatment of Metastatic Melanoma: Current Knowledge and Future Directions

Ralli

Botticelli

Visconti

et al. 2020

Journal of Immunology Research

149

138

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Melanoma is one of the most immunologic malignancies based on its higher prevalence in immune-compromised patients, the evidence of brisk lymphocytic infiltrates in both primary tumors and metastases, the documented recognition of melanoma antigens by tumor-infiltrating T lymphocytes and, most important, evidence that melanoma responds to immunotherapy. The use of immunotherapy in the treatment of metastatic melanoma is a relatively late discovery for this malignancy. Recent studies have shown a significantly higher success rate with combination of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Immunotherapy is associated to a panel of dysimmune toxicities called immune-related adverse events that can affect one or more organs and may limit its use. Future directions in the treatment of metastatic melanoma include immunotherapy with anti-PD1 antibodies or targeted therapy with BRAF and MEK inhibitors.

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Cardiac Immune-Related Adverse Events in Immune Checkpoint Inhibition Therapy

Cited by 21 publications

References 79 publications

Real-world Data Analysis of Immunotherapy in Advanced Lung Cancer

Real-world Data Analysis of Immunotherapy in Advanced Lung Cancer

Real-world data analysis of immune checkpoint inhibitors in stage III-IV adenocarcinoma and squamous cell carcinoma

Immunotherapy in the Treatment of Metastatic Melanoma: Current Knowledge and Future Directions

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