目的:心脏毒性是酪氨酸激酶抑制剂(TKI)和免疫检查点抑制剂(ICI)的常见且报道不足的副作用。基线风险因素可能有助于对心脏毒性风险增加的患者进行风险分层。这项真实世界的研究调查了心脏毒性的基线危险因素对接受TKIs和ICIs治疗的非小细胞肺癌(NSCLC)患者的影响。
方法:这是一项在皇家马斯登医院进行的回顾性研究,英国。新诊断的局部或转移性NSCLC患者接受TKI和/或ICI的抗癌治疗。仅接受化疗的患者被排除在外。从诊断到死亡或出院,对患者进行随访。采用logistic回归分析心脏毒性与危险因素的关系。
结果:88/451(19.5%)患者出现心脏毒性。分析了假设与抗癌治疗引起的心脏毒性有因果关系的危险因素。心脏毒性风险随既往糖尿病增加(OR=1.93,95%CI,1.04-3.61,P=.038),吸烟史(OR=1.91,95%CI,1.13-3.22,P=.016)和基线心血管疾病(OR=2.03,95%CI,1.13-3.64,P=.018).糖尿病吸烟者(OR=3.03,95%CI,1.40-6.55,P<0.01)和既往心血管疾病吸烟者(OR=1.99,95%CI,1.03-3.84,P=.041)发生心脏毒性的风险增加。
结论:糖尿病,当患者暴露于潜在的心脏毒性抗癌剂时,吸烟和基线心血管疾病可能协同作用导致心脏毒性.基线的风险分层可以改善心脏肿瘤护理。
Cardiotoxicity is a common and under-reported side effect of tyrosine-kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI). Baseline risk factors may help in risk-stratifying patients at increased risk of cardiotoxicity. This real-world study investigated the effects of baseline risk factors in cardiotoxicity on patients with non-small-cell lung cancer (NSCLC) treated with TKIs and ICIs.
This is a retrospective study carried out at The Royal Marsden Hospital, UK. Newly diagnosed patients with localized or metastatic NSCLC who received anticancer therapy with TKIs and/or ICIs were eligible. Patients who received only chemotherapy were excluded. Patients were followed up from the time of diagnosis until death or discharge. The relationship between cardiotoxicity and risk factors were tested by logistic regression.
Of 88/451 (19.5%) patients developed cardiotoxicity. Risk factors hypothesized to have a causal relationship with anticancer treatment-induced cardiotoxicity were analyzed. Cardiotoxicity risk was increased with prior diabetes mellitus (OR = 1.93, 95% CI, 1.04-3.61, P = .038), history of smoking (OR = 1.91, 95% CI, 1.13-3.22, P = .016) and presence of baseline cardiovascular disease (OR = 2.03, 95% CI, 1.13-3.64, P = .018). The risk of developing cardiotoxicity increased in patients for smokers with diabetes mellitus (OR = 3.03, 95% CI, 1.40-6.55, P < .01) and for smokers with previous cardiovascular disease (OR = 1.99, 95% CI, 1.03-3.84, P = .041).
Diabetes mellitus, smoking and baseline cardiovascular disease may synergistically contribute to cardiotoxicity when a patient is exposed to potentially cardiotoxic anticancer agents. Risk stratification at baseline may improve cardio-oncology care.