Cardiac Adverse Events of Immune Checkpoint Inhibitors in Oncology Patients: A Systematic Review and Meta-Analysis

BackgroundImmune checkpoint inhibitors (ICIs) are novel therapeutic agents used for various types of cancer. ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients. However, immune-related adverse effects of ICI therapy are common. Cardiovascular immune-related adverse events (irAEs) are rare but potentially life-threatening complications. We aimed to estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies.MethodsWe conducted this systematic review and meta-analysis by searching PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs. We performed a single-arm meta-analysis using OpenMeta [Analyst] software of the following outcomes: myocarditis, pericardial effusion, heart failure, cardiomyopathy, atrial fibrillation, myocardial infarction, and cardiac arrest. We assessed the heterogeneity using the I2 test and managed to solve it with Cochrane’s leave-one-out method. The risk of bias was performed with the Cochrane’s risk of bias tool.ResultsA total of 26 studies were included. The incidence of irAEs follows: myocarditis: 0.5% (95% CI [0.1%-0.9%]); pericardial effusion: 0.5% (95% CI [0.1%-1.0%]); heart failure: 0.3% (95% CI [0.0%-0.5%]); cardiomyopathy: 0.3% (95% CI [-0.1%-0.6%]); atrial fibrillation: 7.6% (95% CI [1.0%-14.1%]); myocardial infarction: 0.4% (95% CI [0.0%-0.7%]); and cardiac arrest: 0.4% (95% CI [0.1%-0.8%]).ConclusionThe most common cardiovascular irAEs were atrial fibrillation, myocarditis, and pericardial effusion. Although rare, data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICI-associated cardiovascular complications.