Cancer treatments have made remarkable progress, leading to more cancer survivors than ever before. However, these treatments can also have serious side effects, including damage to the cardiovascular system. One such concern is the risk of immune checkpoint inhibitors (ICIs) causing cardiotoxicity – harmful effects on the heart and blood vessels.
Researchers from Chongqing Medical University in China have developed a novel strategy to assess the risk of ICI-related cardiotoxicity before treatment even begins. By combining four common clinical biomarkers – cardiac troponin T, high-sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide, and coronary artery calcium score – the team created a multimodal risk scoring system. Their findings show that this scoring approach can effectively stratify patients into different risk categories, with those in the highest-risk group having up to 8 times the risk of developing severe cardiotoxicity compared to the lowest-risk group. This could allow doctors to identify high-risk patients early and take preventive measures to protect their cardiovascular health during cancer treatment.
Protecting the Heart During Cancer Therapy
The past few decades have seen remarkable progress in cancer treatment, thanks to advancements like immune checkpoint inhibitors (ICIs). These revolutionary therapies work by unleashing the body’s own immune system to attack cancer cells. As a result, more and more people are surviving cancer and living longer.
However, these lifesaving treatments can also take a toll on the cardiovascular system. Cardiotoxicity – harmful effects on the heart and blood vessels – is an increasingly recognized side effect of cancer therapies, including ICIs. Conditions like myocarditis, heart failure, and myocardial infarction have been linked to ICI use, and these complications can be severe and even fatal.
Table 1 Multivariable-adjusted ICICT risk of four biomarker results.
Assessing Cardiovascular Risk Before Treatment
To address this problem, a team of researchers from Chongqing Medical University in China set out to develop a strategy for assessing a patient’s risk of ICI-related cardiotoxicity before treatment even begins. They focused on four common clinical biomarkers:
1. Cardiac troponin T (cTnT): A sensitive indicator of myocardial injury
2. High-sensitivity C-reactive protein (hs-CRP): A marker of inflammation
3. N-terminal pro-B-type natriuretic peptide (NT-proBNP): A sign of heart failure
4. Coronary artery calcium (CAC) score: A measure of atherosclerosis
Fig. 2
The researchers analyzed data from 375 cancer patients who had undergone ICI therapy. They found that elevated levels of these four biomarkers before starting treatment were each independently associated with a higher risk of developing various forms of ICI-related cardiotoxicity, including cardiomyopathy, myocarditis, heart failure, and even life-threatening events like myocardial infarction and stroke.
A Multimodal Scoring System
Building on these findings, the team developed a simple scoring system to assess a patient’s overall cardiovascular risk. Patients received 1 point for each biomarker that was elevated above the specified thresholds. This resulted in a total score ranging from 0 (low risk) to 4 (very high risk).
The researchers found that this multimodal scoring approach was more effective at predicting ICI-related cardiotoxicity than any single biomarker alone. Compared to patients with a low-risk score (0-1), those in the very high-risk category (score of 4) had:
– 7.29 times the risk of developing cancer therapy-related cardiomyopathies
– 8.83 times the risk of myocarditis or heart failure
– 7.02 times the risk of a broader range of cardiovascular complications, including myocardial infarction, stroke, and atrial fibrillation
Implications and Future Directions
This study is the first to demonstrate the value of combining these four biomarkers to assess the cardiovascular risk associated with ICI therapy. By providing a simple, clinically feasible way to identify high-risk patients, this approach could allow doctors to take preventive measures and closely monitor those individuals, potentially saving lives.
The researchers note that their study was limited by its retrospective design, and future prospective studies will be needed to further validate the scoring system. Additionally, more work is needed to understand the underlying mechanisms by which these biomarkers contribute to ICI-related cardiotoxicity.
Nevertheless, this multimodal risk assessment strategy represents an important step forward in protecting the cardiovascular health of cancer patients undergoing revolutionary immunotherapy treatments. As cancer survival rates continue to improve, finding ways to mitigate the long-term effects of these therapies will become increasingly crucial.
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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