Abstract 10038: Cardiovascular Impact of Immune Checkpoint Inhibitors: A Systemic Review and Meta-Analysis

Introduction: Immune checkpoint inhibitors (ICIs) have become the cornerstone for treatment of advanced malignancies and have led to long-term tumor responses and improved survival. The body’s immune response to ICIs can lead to unintended consequences (immune-related cardiovascular adverse effects) sometimes involving the heart. Methods: Embase, Ovid, PubMed, and Scopus were searched for ICI randomized phase II or III clinical trials reporting adverse cardiovascular events with combination or monotherapy ICIs (experimental arm) and placebo or standard of care chemotherapy (control arm). The primary outcome was cumulative incidence of cardiovascular adverse effects, and secondary outcomes were isolated incidence of hypertension, myocardial infarction, myocarditis and pericardial effusion. Statistical heterogeneity was quantified using I 2 statistics. Publication bias was assessed with Egger’s regression test. P-value of 0.05 was deemed as statistically significant. Results: Twenty studies (N=13,525) met the inclusion criteria. The studies included 1 small cell and 8 non-small cell lung, 3 renal cell, 1 head & neck, 1 colorectal and 1 prostate cancer with 2 malignant melanoma, 2 multiple myeloma, and 1 mesothelioma. There were 7434 (54.96%) and 6091 (45.04%) patients in the ICI and non-ICI arms, respectively. There was no statistically significant difference in reported cardiovascular toxicity with ICI compared to placebo or standard of care (OR 0.953 95% CI 0.542-1.675, I 2 =89.49 p2 =94.98, P2 =0%, P=0.613), MI (OR 0.76, 95% CI 0.76-3.298 I 2 0%, P=0.83) and myocarditis (OR 2.12, CI 0.638-7.055, I 2 =0%, P=0.185). Conclusions: This meta-analysis demonstrates no significant difference in cardiovascular adverse effects in ICI group when compared to placebo or standard of care.