1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland
Background:
Immune checkpoint inhibitor (ICI) therapy can lead to cardiotoxic side effects in melanoma patients requiring optimal risk stratification. One important biomarker for cardiovascular events is hemoglobin. In non-cancer patients, low hemoglobin values promote left ventricular dysfunction and heart failure, but recent studies also report an association of high level of hemoglobin with cardiovascular mortality. The effects of increased hemoglobin in patients with melanoma or any other type of cancer under ICI therapy are unclear. This study aims to evaluate the predictive capacity of hemoglobin values beyond anemia for cardiovascular toxicity under ICI therapy in melanoma patients.
Methods:
We analyzed 114 melanoma patients (61 ± 13 years; 38% female) without cancer-related anemia (hemoglobin > 11 g/dl) from the prospective Essen Cardio-Oncology Registry (EcoR) receiving ICI therapy. Hemoglobin levels were assessed at patient enrollment before initiation of ICI therapy. The median follow-up was 464 days (interquartile range: 388-540 days). Endpoint was the whole spectrum of cancer-therapy related cardiovascular toxicity (CTR-CVT) according to the European guidelines on cardio-oncology.
Results:
After onset of ICI therapy, we documented 2 cases of myocarditis, 41 cases of cardiac dysfunction (CTRCD), 12 cases of vascular toxicity, 5 cases of arterial hypertension and 12 cases of arrhythmia. Hemoglobin values were associated with overall CTR-CVT by univariate Cox regression (hazard ratio: 1.355; 95% confidence interval (CI): 1.088-1.687; p = 0.007). However, this association was mitigated after further adjustment. Receiver operator characteristic (ROC) curve analysis revealed addition of hemoglobin to a model containing N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and high-sensitive troponin (area under the curve (AUC): 0.602; 95% CI: 0.475-0.728; p = 0.115) increasing model performance (AUC: 0.685; 95% CI: 0.568-0.803; p = 0.002) in this study collective.
Conclusion:
High hemoglobin values are associated with CTR-CVT in melanoma patients without anemia. Additional surveillance of hemoglobin before initiation of ICI therapy might improve risk stratification in these patients.