New research has found immune changes in cancer patients that could help identify which patients are most at risk of dangerous heart complications from cancer drugs, known as immune checkpoint inhibitors.
The study was led by
Assistant Professor Pilar Martin, Head of the Regulatory Molecules of
Inflammation Lab at the Spanish National Centre for Cardiovascular Research
(CNIC) and group leader at CIBER-CV.
She explained, "Immune checkpoint inhibitors
have revolutionised cancer treatment, but they can also damage the hearts of
some patients. In this study, we monitored how levels of immune cells, which
are known to be involved in the development of heart diseases, change after
treatment.
"We were
surprised to see an early and rapid loss of protective immune cells, called
regulatory T cells, after cancer patients started treatment. This suggests a
window of vulnerability early in treatment." Assistant Professor Martin
continued.
The new research is being presented at European
Cardio-Oncology 2025, a scientific congress of the European Society of
Cardiology.
Immune checkpoint
inhibitors are drugs that work by harnessing the patient's own immune response
to attack cancer cells. Unfortunately, they can also have side effects,
including causing heart damage or cardiotoxicity, in some patients.
Approximately 1 in 100 patients treated with these drugs develop myocarditis, a
life-threatening heart complication.
Researchers found that patients with lower levels
of a blood biomarker, called CD69 and found in protective immune cells,
experienced a greater decrease in protective immune cells and a resulting
increase in destructive pro-inflammatory immune cells. Such a decline in
protective immune cells has previously been associated with a greater risk of
developing cardiovascular complications such as myocarditis.
"We put patients into two groups based on
their levels of a protective biomarker called CD69, and saw these groups had
very different response to the cancer treatments. Those who had lower levels of
CD69 before starting treatment had a more negative immune response which puts
them at much greater risk of heart damage," Professor Martin said.
"More work is needed to validate this
biomarker and fully understand the immune changes that are taking place, but
testing patients for this biomarker with a blood test is relatively cheap and
easy and has the potential to help doctors identify which patients are at
greatest risk of complications. This could allow doctors to monitor these
patients more closely, and in time I hope we can develop new treatments to
prevent the immune dysregulation we see in these patients," Professor
Martin continued.
Researchers analysed blood samples from 215
cancer patients from the Spanish Immunotherapy Registry of Cardiovascular
Toxicity (SIR-CVT)2 before treatment and at 24 weeks, 1012 weeks, 6 months, and
1 year after treatment with immune checkpoint inhibitors. The patients had a
range of different cancers, including lung, breast and skin cancer, and were
treated with different types of immune check point inhibitor treatments,
including anti PD1, PDL1 and CTLA4.
Patients were put into two groups dependent the
amount of biomarker for a specific protective T-cell (CD69) in their blood and
changes in levels of their immune cell populations were monitored over time.
While both patient groups experienced some
decline in levels of a specific type of a protective immune cell (CD69 positive
regulatory T cells) in response to treatment, those patients with low starting
levels of the protective biomarker had a much larger decrease. These patients
also had an increase in immune cells with a role to kill other cells and others
that have a role in inflammation.
Regulatory T cells are
found in the blood and are important to maintain immune balance and stop the
immune system damaging healthy tissues, including the heart and blood vessels.
Previous research has shown how the wrong levels of these cells can result in
damage to blood vessels and the heart, and this study suggests they could be
key in mediating the heart damaging effects of immune checkpoint inhibitor
cancer drugs. (ANI)
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