Cardiac biomarkers in patients with renal cell carcinoma treated with immune checkpoint inhibitors.

Clinical evidence to assess the utility of routine cardiac biomarker surveillance during immune checkpoint inhibitor treatment is limited. We examined cardiac biomarkers at baseline and during initial treatment in the JAVELIN Renal 101 phase 3 trial of avelumab plus axitinib vs sunitinib in patients with previously untreated advanced renal cell carcinoma (NCT02684006). At baseline, among available patients, levels of troponin T, troponin I, B-type natriuretic peptide (BNP), and N-terminal pro-BNP were high (per local assay) in 19.8%, 1.5%, 13.0%, and 32.8%, respectively. In addition, a notable proportion of patients developed high cardiac biomarker levels during treatment in both arms. We did not find an association between elevation in cardiac biomarkers and incidence of major adverse cardiac events, although assessment was limited by the small number of events. Overall, these findings suggest that a high proportion of patients with cancer may have elevated cardiac biomarkers at baseline. Therefore, any attempt at routine surveillance of cardiac biomarkers must include testing of the same biomarker at baseline (before initiating cancer treatment).