Background:

Managing cardiovascular adverse events in patients with melanoma gains relevance due to an increasing survival trend and advanced oncological treatment strategies. Therapy with immune checkpoint inhibitors (ICI) is known to possibly induce cardiovascular complications from mild manifestations to life-threatening myocarditis. 2022 ESC guidelines on cardio-oncology suggest cardiovascular toxicity risk assessment before start of cancer therapy to define further diagnostic and therapeutic management based on risk stratification. Determination of Systematic COronary Risk Estimation (SCORE 2) and SCORE2- Older persons (OP) is named as one possible evaluation tool. However, validation for patients undergoing ICI therapy is missing. The aim of this study was to correlate SCORE2 (-OP) with development of cancer therapy-related cardiovascular toxicity (CTR-CVT). 

 

Methods/ Results:

A prospective data analysis of patients, treated in the cardio-oncology unit of West German Heart and Vascular Center, University Hospital Essen, Germany between 2018 and 2021 was performed. In total, 163 patients undergoing ICI therapy (± 13.7 years, 60.7% male) were selected from our Essen Cardio-oncology Registry (ECoR). The study cohort included patients with malignant melanoma (74,2%), non-small cell lung cancer (7.1%), squamous cell carcinoma (6.5%), Merkel cell carcinoma (5.4%), and other cancer entities (6.9%). The ICI therapies were PD-1 inhibitors in 93.8% patients, CTLA4 inhibitors in 43.1% patients and PD-L1 inhibitors in 10.2% patients. SCORE2 (70 years) or SCORE2-OP (≥70 years), respectively, was determined at baseline. Cardiovascular risk stratification was performed according to ESC guidelines and categorized as low, moderate, or high risk. Clinical data including echocardiographic parameters and cardiac biomarkers were collected at baseline and at follow-up after 4-6 weeks and 3 month. According to IC-OS 2021 criteria and 2022 ESC guidelines, 44.8% of the patients developed cancer therapy-related cardiac dysfunction (CTRCD) during ICI therapy, mainly with mild degree. Additionally, myocarditis, vascular toxicity, arterial hypertension, arrhythmias and QTc prolongation occurred. A high SCORE was significantly associated with the development of CTR-CVT. No correlation of higher SCORE with mortality or hospitalization was detected in our cohort.  

 

Conclusion:

SCORE 2 (-OP) is a reasonable a tool for CTR-CVT prediction in patients undergoing ICI therapy. Patients with a high risk SCORE should be carefully supervised and treated in cardio-oncological teams. Long-term data on survival and major cardiac adverse events remains to be seen to what extent the meaningfulness of SCORE2 (-OP) applies to patients undergoing ICI therapy.