Researchers have developed a novel scoring strategy that can accurately assess the risk of cardiotoxicity in cancer patients undergoing immunotherapy treatment. The study, led by a team from Chongqing Medical University in China, combined four common clinical biomarkers – cardiac troponin T (cTnT), high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and coronary artery calcium (CAC) score – to create a multimodal risk assessment tool. The findings suggest that this simple, yet powerful scoring system can help clinicians identify high-risk patients and provide early cardiovascular protection, potentially improving outcomes for those receiving cutting-edge immunotherapy treatments. This research represents a significant step forward in cardio-oncology, a rapidly evolving field focused on managing the cardiovascular impact of cancer therapies.
Tackling the Cardiovascular Risks of Immunotherapy
The increased use of cardio-oncology continues to evolve, this research represents an important step towards personalized risk assessment and tailored management of cardiovascular complications associated with cutting-edge cancer treatments. Future studies may explore the utility of this scoring system in other cancer populations, as well as investigate the potential for dynamic monitoring of biomarker changes during the course of immunotherapy.
Author credit: This article is based on research by Zhulu Chen, Rui Lan, Tao Ran, Li Tao, Yuxi Zhu, Yanwei Li, Chuan Zhang, Min Mao, Diansa Gao, Zhong Zuo.
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 has revolutionized cancer treatment, leading to remarkable improvements in patient outcomes. However, these innovative therapies are not without their challenges, as they can also trigger <b>immune-related cardiotoxicity (ICICT)</b>, a potentially severe and life-threatening side effect.</p>
<p><h3>Combining Biomarkers for Comprehensive Risk Assessment</h3>
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<p>The research team recognized the need for a reliable way to identify patients at high risk of ICICT before starting immunotherapy. They hypothesized that a multimodal approach using several biomarkers could provide a more comprehensive assessment than relying on a single measure.</p>
<p><figure class="wp-block-image size-large"><img decoding="async" src="https://famefreq.s3.us-east-2.amazonaws.com/1729688899_41598_2024_76829_Fig1_HTML.png" alt="figure 1" class="wp-image-1" /><figcaption class="wp-element-caption">Fig. 1</figcaption></figure>
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<p>The researchers analyzed data from 375 cancer patients who underwent immunotherapy at the First Affiliated Hospital of Chongqing Medical University in China. They evaluated four common clinical biomarkers:</p>
<p>1. <b>Cardiac troponin T (cTnT)</b>: a sensitive indicator of myocardial injury<br />
2. <b>High-sensitivity C-reactive protein (hs-CRP)</b>: a marker of inflammation<br />
3. <b>N-terminal pro-B-type natriuretic peptide (NT-proBNP)</b>: a measure of heart failure risk<br />
4. <b>Coronary artery calcium (CAC) score</b>: a marker of subclinical atherosclerosis</p>
<p><figure class="wp-block-image size-large"><img decoding="async" src="https://famefreq.s3.us-east-2.amazonaws.com/1729688903_41598_2024_76829_Fig2_HTML.png" alt="" class="wp-image-2" /><figcaption class="wp-element-caption">Table 1 Multivariable-adjusted ICICT risk of four biomarker results.</figcaption></figure>
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<p>The researchers found that each of these biomarkers, measured before the start of immunotherapy, was independently associated with a higher risk of developing ICICT. They then developed a simple scoring system, assigning one point for each abnormal biomarker result, resulting in a total score ranging from 0 to 4.</p>
<p><h3>Stratifying Risk and Predicting Outcomes</h3>
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<p>The study revealed a clear correlation between the biomarker score and the risk of ICICT. Patients with a “very high” score of 4 had a 7- to 9-fold higher risk of developing ICICT compared to those with a “low” score of 0-1, even after accounting for other potential risk factors.</p>
<p><figure class="wp-block-image size-large"><img decoding="async" src="https://famefreq.s3.us-east-2.amazonaws.com/1729688906_41598_2024_76829_Fig3_HTML.png" alt="figure 2" class="wp-image-3" /><figcaption class="wp-element-caption">Fig. 2</figcaption></figure>
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<p>The researchers also examined the timing and incidence of ICICT events. They found that patients with higher biomarker scores experienced ICICT earlier and had a higher overall incidence of these cardiovascular complications.</p>
<p><h3>Practical Applications and Future Directions</h3>
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<p>This innovative scoring strategy provides clinicians with a straightforward, yet powerful tool to assess a patient’s risk of ICICT before starting immunotherapy. By identifying high-risk individuals, doctors can closely monitor their cardiovascular health and potentially implement early preventive measures, such as closer monitoring or adjustments to treatment plans.</p>
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<p>The researchers emphasize that the four biomarkers used in this study are readily available, cost-effective, and easy to incorporate into routine clinical practice. This accessibility makes the scoring system a practical and scalable solution for improving the safety and outcomes of immunotherapy in cancer patients.</p>
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