Abstract 1684P
Background
The incidence of venous and arterial thromboembolic events in advanced cancer patients treated with immune checkpoint inhibitors (ICIs) has been sporadically reported. We performed a systematic review and meta-analysis to assess the rate of cardiovascular events in patients with melanoma and non-small cell lung cancer (NSCLC) treated with ICIs.
Methods
A systematic search of MEDLINE and EMBASE was performed to identify randomized clinical trials and prospective studies. The main outcomes were venous thromboembolism (VTE), stroke or systemic embolism and myocardial infarction (MI). Secondary outcomes were fatal VTE, fatal stroke or systemic embolism and fatal MI. Pooled proportions with 95% confidence intervals (CI) were calculated using random-effects models.
Results
A total of 59 trials, 25 in 5,578 patients with melanoma and 34 in 6,543 patients with NSCLC were included. In patients with melanoma, rates of VTE, stroke or systemic embolism and MI were 1.5% (95% CI 0.8–2.8), 1.7% (95% CI 0.8-3.7) and 0.4% (95% CI 0.2-0.9), respectively. In patients with NSCLC, the corresponding rates were 1.9% (95% CI 1.2-3.2), 1.2% (95% CI 0.6-2.5), and 1.1% (95% CI 0.5-2.1), respectively. Rates of fatal VTE and MI were similar in melanoma and NSCLC patients. Rates of fatal stroke or systemic embolism were 1.9% (95% CI 0.4-9.5) and 0.7% (95% CI 0.2-2.3) in melanoma and NSCLC patients, respectively. Rate of VTE (3.1% vs. 1.1%) and myocardial infarction (3.4% vs. 0.5%) was higher in NSCLC patients treated with combined-ICIs vs mono-ICIs.
Conclusions
These results highlight a not negligible rate of cardiovascular events in melanoma and NSCLC treated with ICIs. Furthermore, our study identified NSCLC patients receiving combined ICIs as those at high risk to develop severe arterial events including myocardial infarction. Ad hoc randomized clinical trials are needed to assess whether primary prophylaxis is worthy of consideration in high-risk patients receiving ICIs.
Clinical trial identification
NA
Editorial acknowledgement
NA
Legal entity responsible for the study
The authors.
Funding
University of Perugia.
Disclosure
All authors have declared no conflicts of interest.