Cancer patients receiving PD-1 immune checkpoint inhibitors (ICIs) face a significantly heightened risk of heart failure, particularly if they have a prior history of ischaemic heart disease. While PD-1 inhibitors have revolutionized cancer treatment, concerns about their cardiovascular impact are growing.
A preclinical mouse model demonstrated that mice with prior cardiac ischaemia experienced marked dysfunction and inflammation following PD-1 inhibition. In contrast, mice without prior injury showed less severe responses.
Critically, co-treatment with abatacept, a T-cell blocker, appeared to prevent these adverse effects in the animal model.
Supporting these findings, a retrospective study of 1,671 cancer patients found that 6.5% developed new-onset heart failure. Those with a history of ischaemic heart disease showed more than double the risk of developing heart failure after ICI therapy.
Researchers conclude that pre-existing cardiac injury is a key risk factor for ICI-associated heart failure. Patients with a history of ischaemic heart disease may require closer cardiac monitoring during PD-1 inhibitor therapy. The findings emphasize the need for a personalized approach to cancer immunotherapy, balancing treatment benefits with cardiovascular risk.