Incidence of cardiac metastasis (mets) is rising among pts with cancer. Data on the safety and clinical outcomes of ICIs on pts with cardiac mets is limited.
In an international multi-center retrospective study, pts with solid tumors and mets to the heart who had received ICIs were included. Immune-related adverse events (irAEs) were graded according to CTCAE v5.0. Objective response rates (ORR) were evaluated by RECIST when available. Overall survival (OS) and progression-free survival (PFS) were calculated from time of ICI initiation using the Kaplan-Meier Method.
62 pts across 16 institutions were identified with a median follow-up of 38.4 months (mo). Melanoma (33.9%, n=21) and non-small cell lung cancer (NSCLC, 22.6%, n=14) were the most common cancers. Median age at ICI start was 65 (23-89) years and 29.0% (n=18) received combination therapy with anti-PD1/PD-L1 and anti-CTLA4, and 58.1% (n=36) received ICIs as 1st line. Most common locations of cardiac mets were the ventricles (38.7%, n=24) and atria (37.1%, n=23). At ICI initiation, 20.1% (n=13) had a cardiac thrombus. Median diameter of cardiac mass was 4 (0.5-9.0) cm. Cardiology referrals and cardiac MRIs were done on 37/62 (59.7%) and 28/62 (45.2%) pts, respectively. 33.9% had cardiac complications from cancer mets, including arterial/venous emboli (8.1%, n=5), tamponade and arrhythmias (each 6.5%, n=4). For NSCLC, ORR, PFS, and OS were 28.7% (11.7-54.6), 4.3 mo (1.5-11.2), and 9.9 mo (2.0-14.4), respectively. For melanoma, ORR, PFS, and OS were 38.1% (20.8-59.1), 7.5 mo (2.2-19.3), and 35.0 mo (5.4-62.9), respectively. Cardiac mass ORRs for NSCLC and melanoma were 21.4% (7.6-47.6) and 42.9% (24.5-63.5), respectively. iRAEs are shown in the table.
irAE leading to discontinuation 10 (16.1%) Systemic steroids 17 (27.4%) Any grade Grade ≥3 Any irAE 28 (45.2%) 13 (19.4%) Cardiac 1 (1.6%) 0 (0%) Dermatitis 8 (12.9%) 1 (3.2%) Pneumonitis 2 (3.2%) 1 (1.6%) Diarrhea 8 (12.9%) 3 (4.8%) Endocrine 6 (9.7%) 1 (1.6%) Mucositis 1 (1.6%) 0 (0%) Neurologic 1 (1.6%) 1 (1.6%) Hepatitis 1 (1.6%) 1 (1.6%) Other 8 (12.9%) 2 (3.2%)
Cardiac mets are frequently associated with cardiac complications. ICIs have activity in cardiac mets and are safe.
The authors.
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T.K. Choueiri: Financial Interests, Personal, Advisory Board, Advice on GU/RCC drugs: BMS, Pfizer, Merck, Exelixis, AstraZeneca; Financial Interests, Personal, Advisory Board, Advice on Onc drugs: Lilly, EMD Serono, Infinity; Financial Interests, Personal, Advisory Board, Advice on RCC drug: Calithera; Financial Interests, Personal, Invited Speaker, RCC drug: Ipsen; Financial Interests, Personal, Advisory Board, Advice on GU Onc drugs: Surface Oncology; Financial Interests, Personal, Other, Consultant on onc drugs: Analysis Group; Financial Interests, Personal, Invited Speaker, CME, ww2.peerview.com: Peerview; Financial Interests, Personal, Invited Speaker, CME, gotoper.com: PER; Financial Interests, Personal, Invited Speaker, CME, researchtopractice.com: ResearchToPractice; Financial Interests, Personal, Invited Speaker, National Association of Managed Care: NAMC; Financial Interests, Personal, Invited Speaker, ASCO-related event: ASCO-SITC; Financial Interests, Personal, Other, Grant review to Orien Network ($400): ORIEN; Financial Interests, Personal, Advisory Board, Advising oncology strategy: Aptitude Health; Financial Interests, Personal, Invited Speaker, Best of ASCO19 talk: Advent health; Financial Interests, Personal, Invited Speaker, Best of ESMO20 talk ($1000): UAE Society of Onc; Financial Interests, Personal, Invited Speaker, CME, mjhlifesciences.com (OncLive): MJH life sciences; Financial Interests, Personal, Invited Speaker, Grand Rounds: MDACC; Financial Interests, Personal, Invited Speaker, RCC webinar: Cancernet; Financial Interests, Personal, Invited Speaker, CME, Kidney Cancer Association ($1300): France Foundation; Financial Interests, Personal, Invited Speaker, CME, RCC: Springer, WebMed; Financial Interests, Personal, Invited Speaker, CME, ImmunoOncology in RCC: ASiM, CE; Financial Interests, Personal, Invited Speaker, CME, PodCast in RCC ($500.00): Caribou Publishing; Financial Interests, Personal, Invited Speaker, Reimbursement ($432.00): Kidney Cancer Association; Financial Interests, Personal, Other, member of the DSMB for clinical trial: Aravive; Financial Interests, Personal, Invited Speaker, unpaidhttps://www.accru.org/main/public/index.xhtml: ACCRU; Financial Interests, Personal, Invited Speaker, Unpaidhttps://kidneycan.org: KidneyCan; Financial Interests, Personal, Other, External Advisory Board Member: Gustave Roussy; Financial Interests, Personal, Stocks/Shares: Pionyr (not publicly traded), Tempest (publicly traded), Osel (not publicly traded), Nuscan ((not publicly traded)); Financial Interests, Personal, Royalties, For writing and updating chapters in GU Oncology: Up-To-Date online textbook; Financial Interests, Institutional, Funding, National Chair: BMS, Merck, Exelixis, AstraZeneca, Takeda, Tracon, Peloton; Financial Interests, Institutional, Invited Speaker: Roche, Surface Oncology, GSK; Financial Interests, Institutional, Funding, National co-chair: Pfizer, EMD-Serono; Financial Interests, Institutional, Funding, Chair of trial: Lilly; Financial Interests, Institutional, Funding, SC member: Eisai; Financial Interests, Institutional, Funding, National co-chair on 3 ongoing trials: Alliance Cooperative Group; Financial Interests, Institutional, Research Grant, for GU oncology translational research through IION program: BMS; Financial Interests, Institutional, Research Grant, for GU oncology translational research: Exelixis; Financial Interests, Institutional, Research Grant, For Health outcomes research: Roche; Financial Interests, Institutional, Invited Speaker, leads trials as PI: Nikang; Non-Financial Interests, Personal, Leadership Role, Co-Chair of the meeting, 2019-: Kidney Cancer Research Summit of KidneyCAN; Non-Financial Interests, Personal, Principal Investigator, Trial Global and National PI with GU Cancers, mostly Kidney Cancer: Multiple Academic and Industry entities; Non-Financial Interests, Personal, Other, Track Leader/Session chair/Speaker/Discussant: ASCO; Non-Financial Interests, Personal, Other, Speaker/Discussant/Track Leader: ESMO; Non-Financial Interests, Institutional, Other, Access to genomic database: Foundation Med, Guardant, Invitae; Non-Financial Interests, Personal, Other, Grants reviewers: AACR; Non-Financial Interests, Personal, Other, Reviewer of papers: Various journals (e.g. NEJM, Lancet, JCO); Non-Financial Interests, Personal, Other, Medical writing and editorial assistance support (e.g. ClinicalThinking, Envision Pharma Group, Fishawack Group of Companies, Health Interactions, Parexel, Oxford PharmaGenesis, pharmagenesis, and others). However, first draft frequently initiated by myself when I am 1st author: Medical Communication; Non-Financial Interests, Personal, Member: ASCO, AACR; Non-Financial Interests, Personal, Other, Political vote usually as “independent”, not a member of any political party. I am an issue voter: General US Politics; Other, Personal, Other, No financial interest. Institutional.Filed patents related to biomarkers of immune checkpoint blockers, and circulating free methylated DNA. No money made and some patents were abandoned: Filed patents; Other, Personal, Other, Employee at DFCI. Please see https://www.dana-farber.org/ for mission statement (non-profit hospital). I am also the past President of Medical Staff at DFCI 2015-2018: Dana-Farber Cancer Institute (DFCI); Other, Personal, Other, Professor at HMS, Please see https://hms.harvard.edu/ for mission statement (non-profit school): Harvard Medical School (HMS). All other authors have declared no conflicts of interest.