Objectives: In recent years immunotherapy has escalated to frontline treatment options for metastatic non-small cell lung cancer. Cardiovascular toxicity from chemotherapeutic agents is well described in this patient population with common underlying risk factors like smoking. We explored cardiovascular toxicity form the addition of immune checkpoint inhibitors to traditional chemotherapy. Materials and Methods: This is a retrospective study from SEER-Medicare datasets which represents 34 % of the US population. This study included patients age ≥ 65 years-old with newly diagnosed metastatic non-small cell lung cancer between the years 2013 and 2015. Patients were divided into 2 cohorts, one who received traditional chemotherapy only (control arm) and the others who received immune checkpoint inhibitors in addition to traditional chemotherapy (study arm). The primary endpoint was the hazards of new cardiovascular toxicity in the study versus the control arm. Results: We identified 6405 patients who met our study criteria. Of these, 5730 patients received chemotherapy only while 675 patients received chemotherapy and immune checkpoint inhibitors. Results showed that the hazard ratio for all cardiovascular toxicity was 0.81 (95 % CI:0.72−0.91, p = 0.0003) in patients who received immune checkpoint inhibitors with chemotherapy. Among the subgroups, hazards ratio for acute coronary syndrome was 0.82 (95 % CI: 0.64–1.05, p = 0.10), hazards ratio for heart failure was 0.74 (95 % CI: 0.62−0.88, p = 0.0007), hazards ratio for cardiac arrhythmia was 0.72 (95 % CI: 0.63−0.82, p < 0.0001) and hazards ratio for heart blocks was 0.48 (95 % CI: 0.30−0.76, p < 0.0001). There was no significant difference in hazards for cardiomyopathy, pericarditis, and myocarditis between the two cohorts. Patients above 75 years, with comorbidities and pre-existing heart disease, were at higher risk. Conclusions: Results from this study are reassuring that adding immune checkpoint inhibitors to chemotherapy is safe and does not result in increased cardiovascular toxicity but instead showed lower hazards.
Bibliographical noteFunding Information:
This study was completed through the SEER‐Medicare dataset. The SEER program, which is supported by the National Cancer Institute (NCI), contains patient demographics and cancer details for approximately 34 % of the US population. The Medicare dataset, which is maintained by the Centers for Medicare and Medicaid Services (CMMS), contains health care claims and payment information, for over 97 % of the US population aged 65 years or older. This linked SEER-Medicare dataset captures treatment details after the cancer diagnosis from the Medicare insurance program along with individual patient-level demographic and survival data from the SEER cancer registry program. This study done on the available dataset is a retrospective study by design.
- Cardiovascular outcomes
- Immune checkpoint inhibitors