Cardiovascular and oncologic profiles of patients treated with immune checkpoint inhibitors: Insights from the SIR-CVT Registry

The recent expansion of indications for immune checkpoint inhibitors (ICIs) and their increasing use have significantly modified the baseline characteristics of patients receiving these treatments. However, the impact of these changes on cardiotoxicity remains unclear.

This study aims to describe the evolving clinical profile of patients treated with ICIs, with a particular focus on cardiovascular risk factors (CVRF) and oncologic characteristics.

We analyzed the baseline characteristics of a prospective cohort of patients treated with ICI between July 2021 and December 2024, included in the SIR-CVT registry. The cohort was divided into two groups based on recruitment timing: before (ERA1) and after (ERA2) November 2023, when half of the recruitment was completed. Statistical analyses included t-tests and chi-squared tests for continuous and categorical varables, respectively.

A total of 375 patients were evaluated, with 184 in ERA1 and 191 in ERA2 (Table 1). Median age was similar between groups. The proportion of males was significantly higher in ERA1 (77.2% vs 50%, p<0.001). Regarding CVRF, only dyslipidemia showed a higher prevalence in ERA2 (42.9% vs 54.6%, p=0.032). Significant differences in cancer types were observed (p<0.001), with a higher prevalence of lung cancer and melanoma in ERA1, while the proportion of breast cancer and hepatobiliary tumors increased in ERA2. These changes corresponded to an increase in the proportion of patients receiving ICIs in the neoadjuvant setting in ERA2 (4.8% vs 21.5%) and a higher frequency of durvalumab prescriptions in ERA2 (6% vs 13.6%). Additionally, the higher baseline values of Global Longitudinal Strain (GLS) and Left Ventricular Ejection Fraction (LVEF) observed in ERA2 likely reflect a shift in patient characteristics, with a higher proportion of patients being diagnosed at earlier disease stages and receiving ICIs as first-line therapy.

The SIR-CVT registry reveals a shift in the oncologic profile of patients receiving ICIs, driven by evolving treatment indications. The increasing use of ICIs in neoadjuvant settings and curative-intent treatments highlights the need for proactive cardiovascular risk management. As patient profiles continue to change, tailored approaches for monitoring and mitigating immune-related cardiovascular toxicity are warranted to optimize long-term outcomes.