Author + information
- Michael Fradleya,b,
- Rongras Damrongwatanasuka,b,
- Kevin Kipa,b,
- Kullatham Kongpakpaisarna,b and
- Amod Sarnaika,b
Background: Adoptive cellular therapy (ACT) with tumor-infiltrating lymphocytes (TIL) has emerged as an effective treatment option for unresectable Stage III/IV metastatic melanoma. Cardiovascular (CV) toxicity appears to be the dominant manifestation of serious acute toxicities. This is likely due to the additive contribution of each of the three components of the treatment: the preparative chemotherapy, the transferred TIL, and the interleukin-2 (IL2) infusions.
Methods: We abstracted information on 43 patients who received ACT treatment for melanoma at the Moffitt Cancer Center between 2010 and 2016. Student t-tests and chi-square tests were used to compare patient characteristics by presence versus absence of specific CV complications.
Results: The overall adverse CV event rate was 41.9%. Among these patients, 32.6% developed hypotension requiring treatment with intravenous fluids and pressors, 14% atrial fibrillation, and 2.3% troponin elevations suggestive of myocardial damage. No patients developed clinical heart failure, and among the patients that underwent echocardiography, there was no significant difference in mean left ventricular ejection fraction (EF) before or after therapy (62.9% vs. 63.5% respectively, p=0.79). Comparing the patients who developed CV complications to those who did not, there were no significant differences in age, gender, body mass index, race, or prior CV risk factors including hypertension, diabetes or tobacco use. There was also no statistically significant difference in survival between those with and without CV complications (overall survival = 61.9%, mean 26.0 months and progression free-survival=45.2%, mean 18.1 months).
Conclusions: This is the first comprehensive review of cardiac toxicity related to ACT and TIL. Despite the use of lower number of IL2 infusions in these protocols compared to prior studies, cardiovascular complications remain elevated. Further research is needed to define mechanisms and potential prevention strategies to help clinicians manage complications and mitigate risk as this modality becomes more commonly utilized in the treatment of advanced melanoma.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: The Evolving World of LVADs, Transplant and Other Novel Discoveries
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1294-259
- 2017 American College of Cardiology Foundation