Real-world burden of cardiovascular events following immune checkpoint inhibitor therapy: impact on mortality and treatment resumption in 29,503 patients
Menée à partir de données de vie réelle portant sur 29 503 patients atteints d'un cancer traité par inhibiteurs de points de contrôle immunitaire, cette étude évalue l'incidence d'événements cardiovasculaires en lien avec les traitements anticancéreux puis examine l'association entre ces événements indésirables et les interruptions thérapeutiques ou la mortalité
Background: Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but can cause rare, severe cardiotoxicity. The real-world incidence and impact of a broader spectrum of cardiovascular events remains poorly defined. This study aims to evaluate the real-world incidence of cardiovascular events following ICI therapy, explore predictive biomarkers, and assess the impact of treatment interruptions.
Methods: A retrospective observational study using Optum’s de-identified Market Clarity Data was conducted in 29,503 patients receiving ICI therapy for any cancer type with a minimum follow-up of 6 months. Cardiovascular events including myocarditis, arrhythmias, and reduced left ventricular ejection fraction (LVEF < 50%), were analyzed. Kaplan-Meier survival curves were used to evaluate the timing of these events. Biomarkers such as NT-proBNP and troponin were evaluated for their predictive value.
Results: Out of 29,503 ICI-treated patients, 27.6% experienced a cardiac event during the follow-up period (2 years). Patients with pre-existing cardiovascular conditions who were receiving cardioprotective treatment prior to ICI therapy had an increased risk of cardiovascular events (35% vs 20%, p < 0.001). Patients who experienced a cardiac event had a significantly higher mortality rate (39% vs 25.4%, p < 0.001). Elevated troponin and NT-proBNP levels were associated with increased mortality (p < 0.001).
Conclusions: Cardiovascular events are frequent in ICI-treated patients, particularly in those with pre-existing cardiac conditions. Elevated troponin and NT-proBNP levels may serve as useful biomarkers for predicting post-ICI cardiovascular events. These findings demonstrate that these events significantly interrupt ICI therapy and increase mortality. They support biomarker-guided risk stratification and prompt collaboration between oncologists and cardio-oncologists to preserve treatment integrity.
Lung Cancer , résumé, 2026