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Serial Troponin for Early Detection of Nivolumab Cardiotoxicity in Advanced Non-Small Cell Lung Cancer Patients.
- Source :
-
The oncologist [Oncologist] 2018 Aug; Vol. 23 (8), pp. 936-942. Date of Electronic Publication: 2018 Mar 22. - Publication Year :
- 2018
-
Abstract
- Background: Rare cases of severe myocarditis are reported during treatment with nivolumab. Troponin, a biomarker of cardiac damage, is a key component of the diagnostic workup of many cardiac disorders, including myocarditis. This study investigates the role of troponin to assess cardiac involvement during nivolumab therapy for non-small cell lung cancer (NSCLC).<br />Materials and Methods: We evaluated 59 NSCLC patients, analyzing serum samples collected within a translational research study. Troponin above the upper normal limit (0.046 ng/mL) was defined as Tn+, whereas normal but detectable troponin (0.015-0.045) was defined as Tn <superscript>det</superscript> . Troponin alterations were interpreted on the grounds of the following elements: peak values and time curve, cardiac comorbidities, signs and symptoms coincident to troponin elevation, ECG, echocardiography, and disease progression.<br />Results: No patient had cardiovascular events. Among 362 available blood samples, Tn+ (max 0.317 ng/mL) was found in 13 determinations belonging to 6 patients. Seven other patients had isolated Tn <superscript>det</superscript> . In five patients, Tn+ was attributed to cardiac comorbidities, disease progression, or worsening clinical status. One patient without cardiac history and in good clinical condition had a sustained troponin increase-soon after the start of therapy-and after careful evaluation of all relevant elements, it was interpreted as a marker of nivolumab-related subclinical myocarditis.<br />Conclusion: Tn+ may occur in NSCLC patients treated with nivolumab, but in most cases it does not indicate nivolumab cardiotoxicity. In some cases, however, a careful interpretation of troponin alteration, especially at the beginning of therapy, enables identification of subclinical myocarditis, thus allowing early cardiac treatment.<br />Implications for Practice: Myocarditis is a rare but serious adverse event of immune checkpoint blockade with nivolumab, which needs to be recognized as soon as possible. This article suggests that troponin, a user-friendly biomarker of myocardial cytotoxicity, might be useful for early detection of immune-mediated myocarditis. However, because troponin abnormalities might also be related to a number of conditions capable of causing myocardial oxygen demand-supply mismatch, a careful cardiac assessment should be performed in non-small cell lung cancer patients in order to properly interpret any troponin increase. According to the available evidence, monitoring troponin during the first weeks of treatment can be considered reasonable.<br />Competing Interests: Disclosures of potential conflicts of interest may be found at the end of this article.<br /> (© AlphaMed Press 2018.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Immunological pharmacology
Carcinoma, Non-Small-Cell Lung pathology
Cardiotoxicity
Female
Humans
Lung Neoplasms pathology
Male
Middle Aged
Nivolumab pharmacology
Antineoplastic Agents, Immunological therapeutic use
Carcinoma, Non-Small-Cell Lung drug therapy
Lung Neoplasms drug therapy
Nivolumab therapeutic use
Troponin blood
Subjects
Details
- Language :
- English
- ISSN :
- 1549-490X
- Volume :
- 23
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The oncologist
- Publication Type :
- Academic Journal
- Accession number :
- 29567824
- Full Text :
- https://doi.org/10.1634/theoncologist.2017-0452