Chemotherapy or immunotherapy for cancer can also attack the heart – although these side effects are rare, in the worst case they can damage the heart beyond repair. Scientists from the Heidelberg University Hospital and the Sorbonne Université in Paris have recently described a reliable marker for the severity of heart damage in a specific immunotherapy in the renowned journal “Circulation”. This is an “old friend”: the heart muscle protein troponin, which has been used to diagnose heart attacks for around 35 years. In a study with 60 cancer patients who developed heart problems after treatment with so-called immune checkpoint inhibitors, the protein troponin T in the blood showed a severe course of heart muscle inflammation with an increased risk of complications and death above a certain limit. The article was voted “Paper of the Month” by the German Center for Cardiovascular Research in June.
In order to increase the effectiveness of the body’s immune system against tumors, so-called immune checkpoint inhibitors have been increasingly used in cancer therapy for several years. Their development brought about a breakthrough in the treatment of some tumor diseases that were previously difficult or impossible to treat, such as advanced melanoma. However, since these drugs affect an important regulatory mechanism of the immune system that prevents attacks on the body’s own tissue, life-threatening inflammation of various organs can occur during the treatment period. “Inflammation of the heart is particularly critical, since serious heart damage can quickly occur in some of those affected if the severity of the inflammation is not recognized in good time and countermeasures taken,” explains Professor Dr. Norbert Frey, Medical Director of the Clinic for Cardiology. Angiology and pneumology at the UKHD: “There are still no prognostic factors to identify patients at high risk of this severe course as early as possible.”
Around one percent of all patients who receive immune checkpoint inhibitors develop heart muscle inflammation. Since the inflammation usually proceeds without symptoms at first, the treatment guidelines recommend a regular heart check in the first few months of immunotherapy. It is true that heart proteins such as troponin-T are already recorded, which only get into the blood in larger quantities if the heart muscle has been damaged. “Until now, it was only possible to draw conclusions about heart damage as such. Based on our study, we have now defined a precise limit value: If the amount of troponin T in the blood rose above this value in the first 72 hours after administration of the immunotherapeutic drugs, the patients had a high risk of developing a serious heart complication over the next 90 days such as arrhythmias or heart failure,” says first author Professor Dr. Lorenz Lehmann, Clinic for Cardiology, Angiology and Pneumology at the UKHD Based on our results, they are excellent for reliably and practically identifying those patients who need close monitoring and possibly more intensive cardiac support.” Before they can be used in practice, the results have to be confirmed in further studies.
Prof. Lehmann heads the Cardio-Oncology Section of Cardiology and the National Center for Tumor Diseases NCT Heidelberg, in which around 1,200 patients with heart diseases as a result of cancer therapy are cared for in a special consultation every year. This offer is so far unique in Germany and therefore a supra-regional point of contact for those affected.
literature
Lehmann LH, Heckmann MB, Bailly G, et al. Cardiomuscular Biomarkers in the Diagnosis and Prognostication of Immune Checkpoint Inhibitor Myocarditis [published online ahead of print, 2023 Jun 15]. circulation 2023;10.1161/CIRCULATIONAHA.123.062405. doi:10.1161/CIRCULATIONAHA.123.062405
More information on the internet
Cardio-Oncology Section at UKHD
Cardio-Oncology Heidelberg