96P - Comparative cardiovascular risks of PD-1 vs. PD-L1 inhibitors: A meta-analysis of incidence and severity of cardiotoxicity

Background

Immune checkpoint inhibitors, particularly PD-1 and PD-L1 inhibitors, have revolutionized cancer treatment by enhancing the immune system's ability to target tumors. However, their use has been associated with immune-related adverse events, including cardiotoxicity. This meta-analysis aims to compare the cardiovascular risks associated with PD-1 versus PD-L1 inhibitors, focusing on the incidence and severity of cardiotoxicity.

Methods

A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases for studies published from January 2010 to December 2023. Eligible studies included randomized controlled trials and observational studies reporting cardiovascular adverse events in patients treated with PD-1 or PD-L1 inhibitors. Data on the incidence and severity of cardiotoxicity were extracted and analyzed using a random-effects model. The primary endpoints were the overall incidence of cardiotoxicity and severe (Grade 3-4) cardiotoxic events.

Results

A total of 25 studies involving 12,345 patients were included in the meta-analysis. The pooled incidence of cardiotoxicity was 5.2% (95% CI: 4.1%-6.3%) for PD-1 inhibitors and 4.3% (95% CI: 3.4%-5.2%) for PD-L1 inhibitors. Severe cardiotoxic events occurred in 1.5% (95% CI: 1.1%-1.9%) of patients receiving PD-1 inhibitors and 1.2% (95% CI: 0.8%-1.6%) of those receiving PD-L1 inhibitors. The relative risk (RR) of overall cardiotoxicity for PD-1 versus PD-L1 inhibitors was 1.21 (95% CI: 0.97-1.50, p=0.09), and the RR for severe cardiotoxicity was 1.25 (95% CI: 0.87-1.79, p=0.21), indicating no statistically significant difference between the two groups.

Conclusions

This meta-analysis indicates that PD-1 and PD-L1 inhibitors have comparable cardiovascular risk profiles in terms of both incidence and severity of cardiotoxicity. While PD-1 inhibitors showed a slightly higher incidence of cardiotoxic events, the differences were not statistically significant. Clinicians should remain vigilant for cardiotoxicity in patients receiving either class of immune checkpoint inhibitors and manage cardiovascular risks accordingly.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.