Immunotherapy drugs are riskier for treating cancer patients, study suggests

A study published in the European Heart Journal found that the risks of heart problems in cancer patients are higher if they are treated with immunotherapy drugs, which can even lead to death from heart attack. Researchers from the Department of Cardiology at Herlev og Gentofte Hospital, Hellerup, Denmark, revealed that patients diagnosed with lung cancer or malignant melanoma (a type of skin cancer) are treated with immune checkpoint inhibitors as a programmed cell death -1 (PD1 inhibitors) or cytotoxic T lymphocyte associated protein 4 (CTLA-4) inhibitors.

The study’s principal investigator, Dr. Maria D’Souza, a medical doctor and postdoctoral researcher, and her colleagues found that one year after starting treatment with immune checkpoint inhibitors, nearly 10% of 743 cancer patients patients taking PD1 inhibitors (either pembrolizumab or nivolumab) experienced any type of heart problem, ranging from heart failure, irregular heartbeat (arrhythmia), inflammation of the heart (myocarditis or pericarditis), or heart-related death, like a heart attack. The researchers found that patients treated with immune checkpoint inhibitors had an increased risk of heart problems compared to those who were not being treated this way. Within six months of starting treatment, lung cancer patients taking PD1 inhibitors had twice the risk of heart problems; Patients with malignant melanoma had a 4.3-fold increased risk if they were being treated with PD1 inhibitors and a nearly five-fold risk if they were receiving the CTLA-4 inhibitor.

After six months, the risk of heart problems increased slightly for lung cancer patients who received PD1 inhibitors up to a 2.3-fold risk. However, the risk was not statistically significant for PD1 melanoma patients and decreased slightly to a 3.5-fold risk for those who received the CTLA-4 inhibitor. Dr D’Souza said: “We believe this is the first study of this size, based on national data on hospital admissions and drug administration, to investigate the risk of heart problems in lung and melanoma patients treated with dot inhibitors. immune control “.

According to the doctors, they were able to quantify the absolute risks of heart problems over a year in lung cancer patients treated with PD1 inhibitors and in patients with malignant melanoma treated with PD1 or CTLA-4 inhibitors. The findings stated that the risks were higher than previously estimated by the drug safety studies. “We also found that compared to patients who were not receiving immune checkpoint inhibitors, those who were being treated with them had a higher risk of heart problems,” he said. Dr. D’Souza.

The study results showed that the increased risk of heart problems continued beyond the initial six months. “Although these drugs have been rigorously tested in randomized controlled clinical trials before being approved for clinical use, they can still have an impact on organs, causing common and very rare side effects. Large-scale epidemiological studies like ours can contribute. to our knowledge of this with more accurate estimates of how often these side effects occur when drugs are used for clinical treatment, “said Dr. D’Souza.

The researchers say they need more information about the side effects of immune checkpoint inhibitor treatment, and they have launched an observational clinical study of patients receiving these drugs to monitor heart function. As this was an observational study, treatment with immune checkpoint inhibitors was not randomized, factors such as age, sex and time, clinical factors with cancer.

Another limitation was that the study could not reliably analyze the risk of blood vessel problems, such as stroke, because these can take longer to develop than the average follow-up time in the study (164-326 days). In an accompanying editorial, Dr. Tomas Neilan, director of the Cardio-Oncology Program at Massachusetts General Hospital (Boston, USA), and colleagues “Longer-term steps include expanding collaborations with our oncology and pharmaceutical partners, and expanded clinical research efforts in parallel and based on innovative basic experimental knowledge. These and other steps are necessary for this study to advance and we can improve cardiovascular outcomes among our cancer patients treated with an ICI. ” (AND ME)

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