Troponin or not troponin: What is the impact of regular cardiac monitoring for patients treated with immunotherapy?

Background Immune checkpoint inhibitors (ICI) have changed cancer treatment, but they also bring a risk of immune-mediated cardiac toxicities (IMCT), such as myocarditis. Given the rarity but high mortality rates of IMCT, early detection is crucial. Objectives This study aimed to evaluate the impact of our cardiac monitoring algorithm, based on troponin and electrocardiogram follow up, on patients undergoing ICI therapy, assessing whether it reduces treatment interruptions and severe cardiac adverse events. Methods A retrospective study was conducted using data from the West Cancer Institute in Saint Herblain, France. Patients treated with ICIs for lung cancer or melanoma were divided into two groups: group A treated in 2019 (pre-algorithm) and group B treated in 2020–2021 (post-algorithm). The primary objective was to assess the impact of monitoring on the number of treatment cycles canceled or delayed. The secondary objective was to assess the rate of grade 3–4 cardiac or associated adverse events. Results 162 patients were included (45 – group A, 117 – group B). There was no significant difference in treatment interruptions (26.7% vs. 24.8%, p = 0.96). Moreover, the rate of grade 3–4 cardiac or associated adverse events was similar between the two groups (p = 0.2). Conclusions The implementation of the cardiac monitoring protocol had no negative impact on treatment administration but without reduction of severe cardiac or associated immune induced adverse event. This implementation demonstrated good adherence to the procedure; however, further efforts are needed to optimize strategies for the early detection of rare but serious adverse events.