A NEW prospective study highlights the prevalence of elevated cardiac troponin levels in cancer patients receiving immune checkpoint inhibitors (ICIs), offering insights into the early detection of ICI-related myocarditis. This serious immune-related adverse event remains challenging to diagnose, but monitoring high-sensitivity troponin T (hs-TnT) levels could improve risk identification and management.
The study followed 164 patients undergoing ICI therapy for various cancers, including melanoma, over an average of 1.6 years. Researchers analysed hs-TnT trajectories to evaluate their association with ICI-myocarditis. Significant hs-TnT elevations, defined as a 100% rise from baseline with levels ≥28 ng/L, occurred in 16% of patients, while 5% developed myocarditis.
Notably, most significant hs-TnT elevations were asymptomatic and did not confirm myocarditis diagnosis, with 69% of cases lacking additional clinical signs. However, all eight myocarditis cases were preceded by significantly higher hs-TnT elevations compared to asymptomatic patients, suggesting that monitoring these biomarkers could provide critical early warnings.
Despite a high myocarditis incidence, cardiac mortality remained low at 4%, indicating that early detection and intervention might mitigate severe outcomes. The study underscores the importance of regular cardiac monitoring in patients receiving ICIs, particularly those with elevated hs-TnT levels, to prevent complications.
These findings pave the way for integrating biomarker tracking into clinical protocols, enhancing the safety of cancer immunotherapy while maintaining its efficacy.
Reference
Van Den Berg et al. Elevations of Cardiac Troponin in Patients Receiving Immune Checkpoint Inhibitors: Data From a Prospective Study. JACC Adv. 2024;DOI:10.1016/j.jacadv.2024.101375.
