Evidence map›Paper›PMID 40032601›Full record

ArticleJournal for immunotherapy of cancer2025

Safety and efficacy of immune checkpoint therapy for the treatment of patients with cardiac metastasis: a multicenter international retrospective study.

Amin H Nassar, Sarah Abou Alaiwi, Talal El Zarif, Ryan Denu, Walid Macaron, Noha Abdel-Wahab, Dory Freeman, Alexi Vasbinder, Salim Hayeck, Elizabeth Anderson and 52 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal for immunotherapy of cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Article
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

62 authors.

Amin H Nassar *Yale University School of Medicine, New Haven, Connecticut, USA.ORCID http://orcid.org/0000-0002-4507-2396
Sarah Abou Alaiwi *Yale University School of Medicine, New Haven, Connecticut, USA.
Talal El Zarif *Yale University School of Medicine, New Haven, Connecticut, USA.
Ryan DenuDivision of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Walid MacaronDivision of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Noha Abdel-WahabDivision of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Dory FreemanDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Alexi VasbinderDivision of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Salim HayeckDivision of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Elizabeth AndersonDivision of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Rachel S GoodmanDepartment of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee, USA.ORCID http://orcid.org/0000-0001-7992-8108
Douglas B JohnsonDepartment of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee, USA.
Shirly GrynbergElla Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel.
Ronnie ShapiraElla Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel.
Jennifer M KwanYale University School of Medicine, New Haven, Connecticut, USA.
Rachel WoodfordMelanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
Georgina V LongMelanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
Tarek HaykalDuke Cancer Institute, School of Medicine, Duke University, Durham, North Carolina, USA.
Susan DentDuke Cancer Institute, School of Medicine, Duke University, Durham, North Carolina, USA.
Yuki KojimaNational Cancer Center Hospital, Tokyo, Japan.
Kan YonemorNational Cancer Center Hospital, Tokyo, Japan.
Ankita TandonDepartment of Medical Oncology, Loyola University Medical Center, Maywood, Illinois.
Alexandra TrevinoDivision of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Nausheen AkhterDivision of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Eric H YangUCLA Cardio-oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
Gavin HuiUCLA Cardio-oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
Alexandra DrakakiUCLA Cardio-oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
Edward El-AmDepartment of Medicine, Indiana University School of Medicine Eskenazi Hospital, Indianapolis, Indiana, USA.
Elie KozailyDepartment of Medicine, Indiana University School of Medicine Eskenazi Hospital, Indianapolis, Indiana, USA.
Ahmad Al-HaderDepartment of Medicine, Indiana University School of Medicine Eskenazi Hospital, Indianapolis, Indiana, USA.
Elias Bou FarhatBrigham and Women's Hospital, Boston, Massachusetts, USA.
Priyanka BabuYale University School of Medicine, New Haven, Connecticut, USA.
Arjun MittraDivision of Medical Oncology, The Ohio State University, Columbus, Ohio, USA.
Mingjia LiDivision of Medical Oncology, The Ohio State University, Columbus, Ohio, USA.
Nicholas JonesDivision of Medical Oncology, The Ohio State University, Columbus, Ohio, USA.
Javier BaenaDepartment of Medical Oncology, Hospital 12 de Octubre, Madrid, Spain.
Mercedes Juarez HerreraDepartment of Medical Oncology, Hospital 12 de Octubre, Madrid, Spain.
Simone FoderaroDepartment of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
Frank Aboubakar NanaDivision of Pneumology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
Chul KimLombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC, Washington, DC, USA.ORCID http://orcid.org/0000-0003-0191-8684
Paul SacksteinLombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC, Washington, DC, USA.
Kaushal ParikhDivision of Medical Oncology, Mayo Clinic, Rochester, New York, USA.
Aakash P DesaiDivision of Medical Oncology, Mayo Clinic, Rochester, New York, USA.
Caleb SmithDivision of Medical Oncology, Mayo Clinic, Rochester, New York, USA.
Alessio CortelliniOperative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.ORCID http://orcid.org/0000-0002-1209-5735
David J PinatoDepartment of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK.ORCID http://orcid.org/0000-0002-3529-0103
James KorolewiczDepartment of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK.
Nerea Lopetegui-LiaDepartment of Medical Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
Pauline FunchainDepartment of Medical Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
Arrush ChoudharyDivision of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Aarti AsnaniDivision of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Vishal NavaniTom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.ORCID http://orcid.org/0000-0002-6795-009X
Daniel MeyersTom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
Igor StukalinTom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
Jesus Antonio Ocejo GallegosDepartment of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.ORCID http://orcid.org/0000-0002-0664-2376
Jonathan TrentDepartment of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Sanober NusratStephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA.
Carmel MalvarMoores Cancer Center, University of California San Diego, La Jolla, California, USA.
Rana R McKayMoores Cancer Center, University of California San Diego, La Jolla, California, USA.
Tomas G NeilanCardio-Oncology Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Toni K Choueiri *Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA abdulrafeh-naqash@ouhsc.edu toni_choueiri@dfci.harvard.edu.
Abdul Rafeh Naqash *Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA abdulrafeh-naqash@ouhsc.edu toni_choueiri@dfci.harvard.edu.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Physician Scientist Training in Cancer ResearchT32CA009172 · NCI · DANA-FARBER CANCER INSTITUTE · PI Jennifer R Brown, James A. DeCaprio · 1985 to 2026
$17.1M
TRAINING FOR ACADEMIC ONCOLOGY/HEMATOLOGYT32CA009666 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Michael Davies, Courtney DiNardo · 1994 to 2026
$9.8M
Immune-Related Adverse Events in Melanoma Patients Receiving Adjuvant Immune Checkpoint Inhibitor TherapyK01AI163412 · NIAID · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI HASSAN, NOHA ABDELWAHAB HASSAN ALI · 2021 to 2025
$569k
NCATS NIH HHS UL1 TR001863NCI NIH HHS T32 CA009172NCI NIH HHS T32 CA009666NIAID NIH HHS K01 AI163412
6 · The paper itself

Abstract

backgroundData on the safety profiles and clinical outcomes of patients with solid tumors and cardiac metastasis treated with immune checkpoint inhibitors (ICIs) are limited.

methodsThis is an international multicenter retrospective study of patients with cancer and cardiac metastasis at baseline. Patients who had received ≥1 dose of ICI were included. Treatment-related adverse events (trAEs) were graded per Common Terminology Criteria for Adverse Event V.5.0. Objective response rates (ORR) were evaluated by Response Evaluation Criteria in Solid Tumors V.1.1 when available. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method.

resultsAmong 110 pts, median age at ICI initiation was 65 (IQR: 59-75). Median follow-up time since ICI initiation was 36 (95% CI: 26 to 51) months. Melanoma (38%, n=42) and non-small cell lung cancer (24%, n=26) were the most common. 68 (62%) patients received ICIs as first-line, and 29 (26%) patients were treated with combination anti-programmed death-1 and anti-cytotoxic T-lymphocyte antigen 4. The most common location of cardiac metastasis was in the atria (37%, n=41) and ventricles (35%, n=39). 15 patients (13.6%) had bilateral cardiac/pericardial metastasis, 44 (40%) had left-sided, and 43 (39.8%) had right-sided. At ICI initiation, 21% (n=23) had a cardiac thrombus. Cardiology referrals and cardiac MRIs at the time of cancer diagnosis were completed on 58 (53%) and 52 (47%) patients, respectively. Cardiac events occurred in 40 (36%) patients, including arrhythmias (n=14, 13%), arterial/venous emboli (n=4, 3.6%), and cardiac tamponade (n=3, 2.7%). 53 (47%) patients developed trAEs; most common were colitis/diarrhea (n=16, 15%), dermatitis (n=13, 12%), and hepatitis (n=9, 8.2%). ICI-related major cardiac trAEs occurred in 2 (1.8%) patients. 22 patients (20%) developed grade ≥3 trAE. Patients with multiple cardiac metastases had significantly lower responses to ICI-based regimens compared with patients with single cardiac metastasis (11% vs 63%, p=0.02). For melanoma, ORR, median PFS, and median OS were 38%, 9.0 months, and 28.9 months, respectively. 83% of patients with melanoma had concordant responses in overall disease burden and cardiac disease. 91 patients discontinued ICIs, and the main reason was progression or death in 55 (49%) patients.

conclusionsAmong patients with pre-existing cardiac metastasis, ICIs demonstrated meaningful clinical efficacy with no increase in safety signals. Most patients had concordant responses in the overall disease burden and cardiac mass. Multidisciplinary teams are crucial for the appropriate management of patients with cardiac metastasis.

Indexed as

Heart NeoplasmsImmune Checkpoint InhibitorsAgedFemaleHumansMaleMiddle AgedRetrospective StudiesImmune Checkpoint InhibitorsCardiotoxicityImmune Checkpoint Inhibitor

Identifiers

PMID40032601
PMCPMC11877189

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