1250P - Impact of systemic treatment on cardiac events following chemoradiotherapy in stage III lung cancer patients

Background

Radiotherapy (RT) administered in the treatment of lung cancer, has been associated with the development of radiation-induced heart disease. Cardiovascular risk factors (CVRF), prior cardiovascular disease (CVD), RT dosimetry parameters and coronary artery calcium (CAC) have been studied as predictors of symptomatic cardiovascular events. However, there is limited evidence on the impact of chemoradiation (ChTRT) with or without consolidation immunotherapy (IT) in cardiac events in stage III lung cancer.

Methods

We conducted a retrospective study including patients with locally advanced lung cancer treated in our hospital with radiotherapy. Clinical and treatment data, pre-existing CVD and CVRF as well as subsequent cardiac events and survival data were extracted from medical records. RT dosimetry parameters and detection of CAC were obtained from the treatment planning software.

Results

From 2015 to 2022, 195 pts (median age 69 years, range 38 – 89, 71% males) were identified, with stage III NSCLC (84%) and SCLC (16%); primary tumor was left sided in 36% pts. Most pts (96%) presented CVRF and 28% had prior CVD. Among treatment modalities, 63% pts underwent concomitant ChTRT, 28% sequential ChRT and 9% RT alone. Consolidation IT was administered in 20% of patients. With a median follow-up of 25.5 months (range 2,5 - 104 months), 7,2% pts experienced a cardiac event, with a median time to onset of 30.5 months (range 0,5 - 103 months) post RT initiation. Receiving ChT, the number of cycles, type of platinum (cisplatin vs carboplatin) and schedule (concurrent versus sequential ChRT) were not associated with cardiac events. Consolidation was also not associated with the presence of cardiac events. RT dosimetry values (mean heart dose, V30, V40 and V50) were higher in pts presenting cardiovascular events. Previous history of CVD was the only risk factor associated with shorter time to cardiac event.

Conclusions

Cardiac events were present in 7,2% pts after thoracic RT with or without ChT and IT. Higher heart RT dose and previous history of CVD increased the risk of cardiac events, while the addition of systemic therapy had no impact on its appearance.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Hospital de la Santa Creu i Sant Pau.

Funding

Has not received any funding.

Disclosure

S. Martinez Recio: Financial Interests, Personal, Invited Speaker: Pierre Fabre, Sanofi, BMS, Takeda; Other, Meeting registration expenses, travel fees: Merck; Other, Accommodation expenses: Sanofi; Other, Travel fees: Lilly; Other, Meeting registration expenses: BMS, Pfizer, Roche; Other, Meeting registration expenses, travel fees, accommodation expenses: Novartis. A. Barba Joaquín: Financial Interests, Personal, Invited Speaker: Pfizer, MSD, Sanofi, BMS, Novartis, Roche, AstraZeneca, Pierre Fabre; Financial Interests, Personal, Advisory Board: BMS, Sanofi, Roche, AstraZeneca; Non-Financial Interests, Principal Investigator, PI - Clinical Trial C4221016: Pfizer; Non-Financial Interests, Principal Investigator, Clinical Trial CA224-1044: BMS. I.G. Sullivan: Financial Interests, Personal, Advisory Board: Roche, Takeda, Sanofi, Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Roche, AstraZeneca, Takeda. M. Majem: Financial Interests, Personal, Advisory Board: Amgen, Roche, AstraZeneca, Takeda, Janssen, Cassen Recordati, BMS, Sanofi; Financial Interests, Personal, Invited Speaker: Amgen, Roche, AstraZeneca, Pfizer, Takeda, Helsinn; Financial Interests, Institutional, Funding: BMS, AstraZeneca, Roche; Non-Financial Interests, Leadership Role, Board Member: Associacio Contra El Cancer Barcelona. All other authors have declared no conflicts of interest.