Abstract 2035P
Background
Multiple international guidelines suggest that pre-treatment cardiac markers should be taken prior to each cycle of treatment to support the early diagnosis and treatment of immune checkpoint inhibitor (ICI) induced myocarditis (1). As a large regional tertiary cancer centre with an established cardio-oncology service early adoption of baseline and subsequent cardiac surveillance has been implemented and its utility evaluated.
Methods
A retrospective analysis of patients whom had undergone baseline cardiac assessment prior to receiving ICI treatment at the Clatterbridge Cancer Centre between October 2022 and March 2023 was performed. Within the regional protocol all patients with abnormal cardiac markers (Pro-B Naturetic Peptide (Pro-BNP) >400 ng/L and or a high sensitivity troponin T (TropT) >14 ng/L) were subsequently monitored with pre-cycle cardiac biochemical monitoring for the first 3 cycles of ICI treatment.
Results
400 patients who commenced ICI treatment underwent baseline cardiac screening. Of these 169 patients (42.2%) had abnormal biomarkers: 36% (n=61) elevated TropT; 32% (n=54) elevated pro-BNP and 32% (n=54) had elevations in both. Within this cohort 3.3% (n=13) patients were diagnosed with ICI-induced myocarditis; 12 confirmed on cardiac MRI (cMRI) and 1 clinically diagnosed due to clinical instability. Of these 69% (n=9) patients had abnormal baselines and thus had pre-cycle monitoring; 4 did not. Of these 9; 8 were detected through symptoms alone; 1 patient was found to have elevated biomarkers but had already been clinically assessed prior to treatment and had been admitted prior to the biomarker results being reviewed.
Conclusions
Baseline cardiac assessment is useful, as the majority of patients that go on to develop ICI myocarditis have abnormal baseline values. However, the clinical utility of pre-cycle screening has not demonstrated enhanced or earlier detection of myocarditis compared to clinical assessment and represents an area of potential cost saving. Patients are either presenting mid-cycle or are identified via symptomatic review therefore investment is better placed in education and training to optimize clinical recognition and timely management.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
R. Dobson: Financial Interests, Personal, Invited Speaker: BMS, Roche. N. Garbutt: Financial Interests, Personal, Invited Speaker: BMS. T. Guinan: Financial Interests, Personal, Invited Speaker: BMS, MSD, Roche, Sanofi. A.C. Olsson-Brown: Financial Interests, Personal, Invited Speaker: BMS, MSD, Roche, Novartis, AZ, Eisai, B-I. All other authors have declared no conflicts of interest.
Resources from the same session
2096P - Morphine titration with intravenous patient-controlled analgesia for severe cancer pain (Mr.TIPS)
Presenter: Seok Jae Huh
Session: Poster session 06
2097P - Incidence, risk factors (RFs) and management of oral mucositis (OM) in patients (pts) treated with a fluoropyrimidines (FP)-based therapy (tp): A retrospective, monocentric experience
Presenter: Fiorella Manfredi
Session: Poster session 06
2098P - The impact of concomitant use of non-opioid analgesics and immune checkpoint inhibitors on survival in lung cancer patients: A Hong Kong population-based cohort study
Presenter: Zheng-Hao Ye
Session: Poster session 06
2099P - The role of ambulatory blood pressure measurement in TKI-induced arterial hypertension diagnosis
Presenter: Elina Khachaturian
Session: Poster session 06
2100P - An exploratory study of the efficacy and safety of hetrombopag in the treatment of thrombocytopenia induced by concurrent or sequential chemoradiotherapy
Presenter: Jun Wang
Session: Poster session 06
2101P - Bleeding Induced by ANtiCAncer drugs (BIANCA) used breast cancer
Presenter: Nicolas Janus
Session: Poster session 06
2102P - Changes in opioid usage after intrathecal morphine pump implantation in patients with terminal cancer (pilot study)
Presenter: Eun Joo Choi
Session: Poster session 06
2103P - Phase Ib, international, dose-escalation study to evaluate the safety, pharmacokinetics (PK) and efficacy of ST-617 a dithiolethione, for the attenuation of oral mucositis (OM) in patients receiving chemoradiation (CRT) for head & neck (H&N) cancer
Presenter: Daniel Osei-Fofie
Session: Poster session 06
2104P - Prevention of taxane chemotherapy induced nail changes and peripheral neuropathy by application of extremity cooling: A prospective single center study with intrapatient comparison
Presenter: Kristen Johnson
Session: Poster session 06
2105P - Prophylactic role of a postbiotic microbiota-stabilizer on abemaciclib-induced diarrhea in breast cancer patients: A pilot application study
Presenter: Rita De Sanctis
Session: Poster session 06