背景:尽管人们越来越意识到免疫检查点抑制剂(ICIs)在治疗肺癌时引起的心脏毒性,其发病率尚未进行系统分析。这项研究旨在评估与ICI治疗肺癌相关的心脏毒性的发生率。从而提高临床医生对心脏毒性的关注,对高危患者实施适当的预防和干预,并将治疗期间和完成后心功能不全的风险降至最低。
方法:我们从成立到2022年4月19日,对PubMed和Scopus的相关出版物进行了系统的文献检索。计算心脏毒性事件的合并发生率和风险比以及95%置信区间(95%CIs)。
结果:共37项研究,涵盖38项试验,包括14342名患者,已确定。任何心脏不良事件的合并风险比为1.944[95%CI0.8-4.725](单一ICI与化疗),1.677[95%CI1.065-2.64](单次ICI加化疗与化疗),和0.478[95%CI0.127-1.798](单ICI与双ICI)。心肌炎和心律失常的发生率分别为0.003[95CI0.002-0.006]和0.014[95CI0-0.037],分别。
结论:与化疗相比,单一ICI并未增加心脏毒性的风险,与单纯化疗相比,单一ICI加化疗使心脏毒性风险增加67%.与单一ICI相比,联合免疫疗法并未增加心脏毒性的风险。
BACKGROUND: Although people are more and more aware of the cardiotoxicity caused by immune checkpoint inhibitors (ICIs) in the treatment of lung cancer, its incidence rate has not been systematically analyzed. This study aims to evaluate the incidence of cardiotoxicity related to the ICI therapies for lung cancer, so as to enhance clinicians\' attention to cardiotoxicity, implement proper prevention and intervention for high-risk patients, and minimize the risk of cardiac dysfunction during and after completion of therapy.
METHODS: We conducted a systematic literature search for relevant publications in PubMed and Scopus from inception to 19 April 2022. Pooled incidence and risk ratios with 95% confidence intervals (95% CIs) for cardiotoxicity events were calculated.
RESULTS: A total of 37 studies covering 38 trials, including 14,342 patients, were identified. The pooled risk ratios of incidence of any cardiac AEs were 1.944 [95% CI 0.8-4.725] (Single ICI versus chemotherapy), 1.677 [95% CI 1.065-2.64] (Single ICI plus chemotherapy versus chemotherapy), and 0.478 [95% CI 0.127-1.798] (Single ICI versus Dual ICI). The incidence of myocarditis and arrhythmia were 0.003[95%CI 0.002-0.006] and 0.014[95%CI 0-0.037], respectively.
CONCLUSIONS: Single ICI did not increase the risk of cardiotoxicity compared with chemotherapy, and single ICI plus chemotherapy increased the risk of cardiotoxicity by 67% compared with chemotherapy alone. Combination immunotherapy did not increase the risk of cardiotoxicity compared with single ICI.