Cardiotoxicity associated with immune checkpoint inhibitors: Systematic review and meta-analysis

IF 5.5 2区医学 Q1 HEMATOLOGY Critical reviews in oncology/hematology Pub Date : 2025-02-01 DOI:10.1016/j.critrevonc.2024.104587

Lavinia Piazza , Anna Carollo , Enrica Di Martino , Maria Eugenia Novara , Sofia Cutaia , Alessio Provenzani , Sergio Rizzo

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Abstract

Background and aims

The aim of this systematic review was to assess the risk of cardiac toxicity in patients undergoing approved PD-1 (nivolumab, pembrolizumab, cemiplimab, dostarlimab), PD-L1 (atezolizumab, avelumab, durvalumab), and CTLA-4 (ipilimumab) inhibitors.

Results

Among a total of 2272 articles, 11 phase II and III clinical trials included: 5463 patients and 175 cardiac adverse events. The most common cardiac disorder was atrial fibrillation (12 %), while cardiac arrest and cardiac failure (6 %) led to death in three cases. Overall, ICI treatment increased the risk of cardiotoxicity compared with control groups (RR=1.62, 95 %-CI= 1.18–2.24, p-value=0.0033; OR=1.71, 95 %-CI= 1.20–2.42, p-value=0.0027).

Conclusions

This study proved that the recognition of frequency and severity of all grade cardiotoxicity associated with ICIs is still underestimated. Thus, a systematic cardiological screening becomes necessary, in order to intercept the potential cardiological complications beforehand and optimize the outcomes of the respective treatment with PD-1, PD-L1 and CTLA-4 inhibitors.

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与免疫检查点抑制剂相关的心脏毒性：系统回顾与元分析。

背景和目的：本系统评价的目的是评估接受批准的PD-1 (nivolumab, pembrolizumab, cemiplimab, dostarlimab), PD-L1 （atezolizumab, avelumab, durvalumab）和CTLA-4 （ipilimumab）抑制剂的患者心脏毒性的风险。结果：在总计2272篇文章中，11项II期和III期临床试验包括：5463例患者和175例心脏不良事件。最常见的心脏疾病是房颤（12%），而心脏骤停和心力衰竭（6%）导致3例死亡。总体而言，与对照组相比，ICI治疗增加了心脏毒性的风险(RR=1.62, 95% ci = 1.18-2.24， p值=0.0033；OR=1.71, 95%-CI= 1.20-2.42， p值=0.0027)。结论：本研究证明，对与ICIs相关的所有级别心脏毒性的频率和严重程度的认识仍然被低估。因此，有必要进行系统的心脏病筛查，以便预先拦截潜在的心脏病并发症，并优化PD-1， PD-L1和CTLA-4抑制剂各自治疗的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical reviews in oncology/hematology 医学-血液学

CiteScore

11.00

自引率

3.20%

发文量

213

审稿时长

55 days

期刊介绍： Critical Reviews in Oncology/Hematology publishes scholarly, critical reviews in all fields of oncology and hematology written by experts from around the world. Critical Reviews in Oncology/Hematology is the Official Journal of the European School of Oncology (ESO) and the International Society of Liquid Biopsy.