The Impact of Immune-Related Adverse Events on the Survival of Patients Treated with Immune Checkpoint Inhibitors: The Distinct Role of Cardiac Toxicities

Pătru, Ileana-Raluca; Anghel, Alexandra-Valentina; Galeschi, Eusebiu Robert; Bătăuș, Lorena Carolina; Ionescu, Andreea-Iuliana; Negru, Alina Gabriela; Barbu, Maria Alexandra; Iordache, Maria; Antone-Iordache, Ionuț-Lucian

doi:10.3390/jcm14217794

Open AccessArticle

The Impact of Immune-Related Adverse Events on the Survival of Patients Treated with Immune Checkpoint Inhibitors: The Distinct Role of Cardiac Toxicities

by

Ileana-Raluca Pătru

^1,2,

Alexandra-Valentina Anghel

²

,

Eusebiu Robert Galeschi

²,

Lorena Carolina Bătăuș

²,

Andreea-Iuliana Ionescu

^1,2,3,*,

Alina Gabriela Negru

⁴

,

Maria Alexandra Barbu

⁵,

Maria Iordache

^1,2 and

Ionuț-Lucian Antone-Iordache

^2,3

¹

Medical Oncology Department, Colțea Clinical Hospital, 030167 Bucharest, Romania

²

Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania

³

Radiotherapy Department, Colțea Clinical Hospital, 030167 Bucharest, Romania

⁴

Cardiology Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania

⁵

Medical Oncology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(21), 7794; https://doi.org/10.3390/jcm14217794

Submission received: 10 October 2025 / Revised: 27 October 2025 / Accepted: 31 October 2025 / Published: 3 November 2025

(This article belongs to the Section Oncology)

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Abstract

Background: Immunotherapy with immune checkpoint inhibitors (ICIs) has fundamentally transformed cancer treatments. Unfortunately, its benefits are accompanied by the occurrence of immune-related adverse events (irAEs). While non-cardiac irAEs have been consistently associated with a favorable prognosis, the impact of cardiac toxicities remains insufficiently explored. Methods: We conducted a retrospective, observational study at the Oncology Department of Colțea Clinical Hospital, Bucharest. All the patients treated with ICIs between 1 May 2019 and 1 February 2024 were selected in the initial cohort. Of 512 eligible patients, 435 were included in the final analysis, with comprehensive recordings of clinical, oncological, and cardiac monitoring parameters, and at least one complete cycle of ICI treatment. Adverse events were classified according to CTCAE v5.0, and overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan–Meier estimates and Cox regression models. Results: Our results showed that patients who developed non-cardiac irAEs experienced a significant survival benefit: median OS 26.0 months (95% CI, 15.5–NA) vs. 13.9 months (95% CI, 12.4–16.5), 0.66 (95% CI, 0.49–0.9) hazard ratio (HR); median PFS 12.3 months (95% CI, 8.1–26.0) vs. 8.7 months (95% CI, 7.3–10.3), 0.74 (95% CI, 0.56–0.97) HR. Conversely, patients with cardiac toxicities did not derive the same advantage, with similar OS and PFS values that did not reach statistical significance: median OS 15.0 months (95% CI, 13.3–19.3) vs. 15.8 months (95% CI, 12.0–30.3), 1.11 (95% CI, 0.78–1.57) HR; median PFS 9.1 months (95% CI, 7.6–10.4) vs. 8.1 months (95% CI, 5.3–19.3), 1.003 (95% CI, 0.72–1.39) HR. Conclusions: These findings support the role of non-cardiac irAEs as markers of favorable therapeutic response, while cardiac irAEs do not confer the same prognostic benefit. The results underscore the importance of active cardiovascular monitoring and close multidisciplinary collaboration in the management of patients receiving ICIs.

Keywords: immune checkpoint inhibitors; immune-related adverse events; cardiotoxicity; survival analysis; progression-free survival; real-world data

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MDPI and ACS Style

Pătru, I.-R.; Anghel, A.-V.; Galeschi, E.R.; Bătăuș, L.C.; Ionescu, A.-I.; Negru, A.G.; Barbu, M.A.; Iordache, M.; Antone-Iordache, I.-L. The Impact of Immune-Related Adverse Events on the Survival of Patients Treated with Immune Checkpoint Inhibitors: The Distinct Role of Cardiac Toxicities. J. Clin. Med. 2025, 14, 7794. https://doi.org/10.3390/jcm14217794

AMA Style

Pătru I-R, Anghel A-V, Galeschi ER, Bătăuș LC, Ionescu A-I, Negru AG, Barbu MA, Iordache M, Antone-Iordache I-L. The Impact of Immune-Related Adverse Events on the Survival of Patients Treated with Immune Checkpoint Inhibitors: The Distinct Role of Cardiac Toxicities. Journal of Clinical Medicine. 2025; 14(21):7794. https://doi.org/10.3390/jcm14217794

Chicago/Turabian Style

Pătru, Ileana-Raluca, Alexandra-Valentina Anghel, Eusebiu Robert Galeschi, Lorena Carolina Bătăuș, Andreea-Iuliana Ionescu, Alina Gabriela Negru, Maria Alexandra Barbu, Maria Iordache, and Ionuț-Lucian Antone-Iordache. 2025. "The Impact of Immune-Related Adverse Events on the Survival of Patients Treated with Immune Checkpoint Inhibitors: The Distinct Role of Cardiac Toxicities" Journal of Clinical Medicine 14, no. 21: 7794. https://doi.org/10.3390/jcm14217794

APA Style

Pătru, I.-R., Anghel, A.-V., Galeschi, E. R., Bătăuș, L. C., Ionescu, A.-I., Negru, A. G., Barbu, M. A., Iordache, M., & Antone-Iordache, I.-L. (2025). The Impact of Immune-Related Adverse Events on the Survival of Patients Treated with Immune Checkpoint Inhibitors: The Distinct Role of Cardiac Toxicities. Journal of Clinical Medicine, 14(21), 7794. https://doi.org/10.3390/jcm14217794

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The Impact of Immune-Related Adverse Events on the Survival of Patients Treated with Immune Checkpoint Inhibitors: The Distinct Role of Cardiac Toxicities

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