97P - Cardiac risk stratification and serial monitoring during immune checkpoint inhibitor therapy: Prospective real-world experience

Background

Myocarditis is a rare adverse effect of immune-checkpoint inhibitor therapy (ICI) associated with a high fatality rate and no clear predeterminants. European Society of Cardiology suggests baseline cardiac assessment and serial monitoring with ICI treatment. The volume of investigations recommended has been a barrier to adoption in practice.

Methods

We conducted a prospective study of clinical utility of baseline and serial cardiac assessment in a UK tertiary hospital. Patients were risk stratified by cardiac history, risk factors, baseline bloods including cardiac biomarkers and cardiac investigations, repeated at 3-4 weeks and 6-8 weeks. Aims; test feasibility; assess the value in risk stratifying patients to predict risk; determine if serial monitoring identified early cardiac toxicity.

Results

175 patients, 86 High risk, 89 Low risk. 8/175 patients baseline troponin >30. 28/175 patients baseline BNP >400. 2 patients had a troponin rise at 3-4 week, neither developed cardiotoxicity. 7 developed a troponin rise at 6-8 weeks, none developed cardiotoxicity. 32 patients had a BNP rise at 3-4 weeks. 9 significant. 1 patient BNP increased to >1000 without cardiotoxicity. 5 patients BNP approximately doubled; 2 patients rose >1000, 1 without cardiotoxicity, 1 who developed myocarditis later. 2 symptomatic patients with raised biomarkers and were treated for cardiotoxicity. 1 presented in SVT, LVEF 33%, CMR negative for myocarditis. 1 with syncopal episodes. In both cases biomarkers reduced on steroids, ICI was terminated.

Conclusions

All patients who developed cardiotoxicity were screened as high risk. 2 patients with cardiotoxicity were identified through clinical assessment not serial monitoring. Interpretation of cardiac biomarkers should accompany careful clinical assessment and liaison with cardiology. Baseline assessment supports decision making. Risk stratification may be a way to streamline monitoring.

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.