Troponin and NTproPNB levels before starting cancer therapy with immune checkpoint inhibitors can predict all-cause mortality

The 2022 ESC Guidelines on cardio-oncology recommend measuring cardiac biomarkers, troponin and natriuretic peptides (e.g. NTproBNP), in patients initiating treatment with immune checkpoint inhibitors (ICI). The main goal is to stratify the risk of cardiovascular events. Nobody has verified the value of these biomarkers in predicting anticancer treatment efficacy and mortality.

The aim of the study was to assess a value of troponin and NTproBNP levels determined before the start of cancer therapy with ICI in an assessment of anticancer treatment effectiveness expressed by time to treatment failure (TTF) and overall survival (OS).

TTF was defined as time from the beginning of treatment with ICI to a moment of premature termination due to a diagnosis of unacceptable toxicity, progression of cancer disease or all-cause death. OS included all-cause death as endpoint of observation.

The study based on analysis of electronic data (Clininet) of the National Research Institute of Oncology. The inclusion criteria were: beginning of treatment with ICI in the period August 2016 - April 2025 diagnosis of melanoma or lung cancer or breast cancer or renal carcinoma (ICD-10: C43, C34, C50, C64) treatment with niwolumab or pembrolizumab or niwolumab+ipilimumab available results of troponin or NTproBNP determined by oncologists before cancer therapy with ICI.

Among 3295 patients treated with ICI: 1411 (42,8%) and 1369 (41,5%) had evaluated troponin or NTproBNP, respectively.

Among 1411 patients with available baseline troponin before ICI treatment: 1104 (78.2%) patients had value <14 ng/L and 307 (21.8%) had abnormal elevated value > 14 ng/L.

Among 1369 patients with available baseline NTproBNP before ICI treatment: 680 (49.7%) patients had value < 125 pg/ml and 689 (50.3%) patients had abnormal elevated value > 125 pg/ml.

The patients with pre-existing elevated troponin level had significantly shorter TTF (4.2 vs 9.1 months, log-rank p<0.0001) and OS (13.9 vs 38.7 months, log-rank p<0.0001).

The patients with pre-existing elevated NTproBNP level had significantly shorter TTF (4.9 vs 10.8 months, log-rank p<0.0001) and OS (17.3 vs 54.3 months, log-rank p<0.0001).

Elevated cardiac biomarkers may help oncologists to predict an outcome of patients treated with ICI: a need for premature termination for any reason and all-cause mortality.

The study clearly confirms the validity of the assessment of these biomarkers in all cancer patients before treatment with ICI.