Cardiovascular toxicity related to immune checkpoint inhibitor (ICI) therapy is “common” in patients with lung cancer, according to findings presented at the 2023 World Conference on Lung Cancer.

Researchers found that lung cancer patients had a significantly increased risk of myocardial infarction, pericardium diseases, conduction disorder, and tachyarrhythmia after starting ICI therapy.

For this study, researchers evaluated 1803 patients with lung cancer who were treated with ICIs at a single center from April 1, 2016, to March 31, 2020. The median age of the patients was 66 years.

Continue Reading

Heart disease at baseline was documented for 26.0% of the patients. More than three-quarters of patients (77.8%) were treated with a single ICI over the study period, while 22.2% received multiple ICIs. The minimum follow-up for analysis was 18 months after ICI initiation.

New cases of cardiac disease documented after patients started ICI therapy included tachyarrhythmia (20.4%), diseases of the pericardium (9.4%), heart failure (5.2%), myocardial infarction (3.4%), conduction disorder (3.1%), valvular heart disease (3.3%), cardiomyopathy (2.7%), cardiac arrest (1.4%), endocarditis (0.9%), myocarditis (0.6%), other heart diseases (5.6%), and other ischemic heart diseases (12.0%).

The median time to a first cardiovascular event after ICI initiation ranged from 2.8 months for myocarditis to 11.1 months for valvular heart disease.

An adjusted analysis revealed a significantly increased risk of the following cardiovascular events after ICI therapy:

  • Conduction disorder (hazard ratio [HR], 2.88; 95% CI, 1.7-4.9; P <.001)
  • Myocardial infarction (HR, 1.92; 95% CI, 1.14-3.23; P =.014)
  • Pericardium diseases (HR, 1.47; 95% CI, 1.06-2.03; P =.022)
  • Tachyarrhythmia (HR, 1.42; 95% CI, 1.14-1.78; P =.002).

In a competing risk analysis, the researchers found that patients receiving multiple ICIs had a significantly higher cumulative incidence of new heart disease diagnoses than patients receiving a single ICI (P <.001). However, the cumulative incidence of death was higher in patients receiving a single ICI than in those who received multiple ICIs (P =.001).

“[C]ardiovascular events associated with ICI therapy are common in lung cancer patients,” said study presenter Sai-Ching J. Yeung, MD, PhD, of the University of Texas MD Anderson Cancer Center in Houston. “Multiple ICI treatment carries a higher risk of cardiovascular diseases after immune checkpoint inhibitor initiation when compared with single ICI treatment. The scope of cardiovascular diseases in lung cancer patients treated with ICI is way beyond myocarditis and pericarditis.”

Disclosures: No disclosures were provided.


Yeung S-C, Qdaisat A. Reported cardiovascular events in lung cancer patients after immune-checkpoint inhibitor therapy. Presented at WCLC 2023. September 9-12, 2023. Abstract OA14.06.