3557 - Does Thoracic Radiotherapy Combined with Immune Checkpoint Inhibitors Increase Cardiac Toxicity? — A Systemic Review and Meta-Analysis
Presenter(s)
Y. Wu1, Y. Chen2, J. Wang1, Y. Zhou3, N. Zhang4, and X. Li5; 1Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 2the Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 3Hebei General Hospital, Shijiazhuang, China, 4Shijiazhuang People’s Hospital, Shijiazhuang, China, 5the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
Purpose/Objective(s):
The combination of thoracic radiotherapy (TRT) and immune checkpoint inhibitors (ICIs) has altered treatment landscape of non-small cell lung cancer (NSCLC) and esophageal carcinoma (EC). However, severe adverse events (AEs), particularly life-threatening cardiac toxicity, have emerged as a critical concern. This systematic review and meta-analysis aim to estimate the incidence of cardiac AEs in patients with NSCLC and EC who are receiving TRT in combination with ICIs.Materials/Methods:
PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched through October 13, 2024. According to Population, Intervention, Comparison, Outcomes and Design (PICOD), key inclusion criteria were studies involving patients with NSCLC and EC treating with TRT and ICIs and reporting cardiac toxicity data. Studies with fewer than 10 patients in each group, case reports, protocols, letters, reviews, and editorials were excluded. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and meta-analysis of Observational Studies in Epidemiology (MOOSE). Statistics utilized Mantel-Haenszel fixed-effect or random-effect model depending on the heterogeneity (I^2). The primary outcomes were incidence and types of any grade and grade =3 cardiac AEs.Results:
Among the 125 included studies, the estimated incidence of cardiac AEs was 0.9% (95% CI 0.5%-1.4%), with grade =3 cardiac AEs occurring in 0.2% (95% CI 0.1%-0.3%). For NSCLC patients, the incidence of any grade and grade =3 cardiac AEs were 0.7% (95% CI 0.3%-1.2%) and 0.2% (95% CI 0.1%-0.4%), respectively. For EC, they were 1.4% (95% CI 0.4%-2.9%) and 0.1% (95% CI 0.0%-0.3%). Common AEs included grade 1-2 abnormal cardiac enzymes (11.70%), myocarditis (5.85%), and grade 3-5 myocarditis (5.85%), with heart failure occurring in 3.72%.Conclusion: The overall risk of cardiac toxicity following thoracic radiotherapy combined with ICIs appears to be relatively low, with an overall incidence of 0.9%, and clinical manifestation is various. Grade 3-5 AEs are rare but it should not be ignored due to its high fatality Early recognition and timely management are essential. Prospective clinical trials are highly warranted.