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B. Grant
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P2.07 - Immunology and Immunotherapy (ID 708)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.07-051 - Immune Checkpoint Associated Cardiotoxicity: An Update (ID 10393)
09:30 - 09:30 | Author(s): B. Grant
- Abstract
Background:
Immune checkpoint inhibitors have revolutionized the field of oncology. nivolumab, pembrolizumab, ipilimumab, and atezoluzimab have been approved by the United States Food and Drug Administration for various malignancies. Because these antibodies rely on activating the host immune system, unique autoimmune side effects have been discovered, including reactions against the cardiovascular system. We would like to summarize our institutional experience with immune checkpoint inhibitor associated cardiotoxicity and review the current literature on this subject.
Method:
Retrospective review of the patient medical record and review of PubMed indexed literature on immune checkpoint inhibitor associated; cardiotoxicity, cardiomyopathy, autoimmune myocarditis, heart failure.
Result:
To date we have experienced two cases of immune checkpoint inhibitor associated cardiotoxicity in our patients treated at Markey Cancer Center, Lexington Kentucky. Both these patients were treated for metastatic non-small cell lung cancer who had previously progressed on frontline chemotherapy. Both patients received nivolumab. One of the patient developed congestive heart failure within couple of days after first dose of nivolumab. Extensive cardiac workup for ischemia was negative. On returning of cardiac functions to baseline he was re-challenged with second dose of nivolumab. Patient again developed decomensated CHF with ejection fraction of 30-40%. Subsequent therapy was aborted. Patient continues to have stable disease off therapy for the past 8 months. Our second patient developed moderate to severe pericardial effusion after fifth dose of nivolumab. Pericardial fluid cytology was negative for malignancy and CT scans showed stable visceral metastatic disease. He is currently off therapy and will get a prolonged 8 week steroid taper. Our literature review revealed only nineteen documented cases of immune checkpoint mediated cardiotoxicity. Seventeen of the 19 patients had metastatic melanoma; the remaining two had non-small cell lung cancer (one adenocarcinoma and one squamous cell). Six of the 19 patients developed cardiotoxicity within five weeks of treatment initiation. One of the patients developed biopsy confirmed immune mediated cardiotoxicity 31 weeks after initiation of treatment. Seven patients were treated with ipilimumab alone, four with nivolumab, one with pembrolizumab and the remaining seven patients received a combination of PD1/PDL-1 and CTLA-4 antibody either sequentially or concurrently. Six out of 19 patients died from toxicity of the respective drugs.
Conclusion:
Immune checkpoint associated cardiotoxicity is rare but well defined in literature. Patients can present with decompensated heart failure, arrhythmia or pericardial effusions. Early recognition, prolonged steroid taper and optimization of cardiac function with diuretics, ACE inhibitors and beta blockade are critical steps for the successful management.
