Cardio-oncology & otherCohort study
Incidence and risk factors of immune checkpoint inhibitor myocardial and muscle toxicity: a French nationwide study
- Retrospective cohort study
- nationwide
- French National Health Data System
Authors' conclusion
This pharmaco-epidemiological study assessed >170 000 French patients treated by ICI in real life, establishing the incidence and identifying risk factors of developing ICI myotoxicities, with severity surrogates associated with fatality.
Study context
- Population
- Adults starting immune checkpoint inhibitor (ICI) therapy in France, 1 January 2012–30 September 2022
- Participants
- 172,363 adults
- Outcome
- Occurrence of ICI myotoxicities
Main finding
As reported in the abstract
ICI myotoxicity incidence · 6 months
Incidence of ICI myotoxicities (narrow or broad definition)
0.7%–0.9%
Incidence in thymic cancer
up to 7.1%
Observational data: associations, not effects.
Secondary outcomes
Risk factors for ICI myotoxicities (broad, n = 1520) · 6 months
| Comparison | sHR | |
|---|---|---|
| thymic tumour | 12.94 (95% CI 5.22–32.03) | |
| melanoma | 2.41 (CI 2.06–2.83) | |
| other skin cancers | 2.07 (CI 1.55–2.76) | |
| history of thymic disorders | 5.61 (CI 2.66–11.86) | |
| history of myasthenia gravis | 2.50 (CI 1.45–4.32) | |
| combination of ICI | 2.44 (CI 1.99–2.98) | |
| 0.050.21520Subdistribution hazard ratio (log scale) |
| Outcome | sHR (CI) | |
|---|---|---|
| Risk factors for ICI myotoxicities (broad, n = 1520) · 6 months — age > 85 vs <45 years | 1.79 (1.24–2.59) | |
| 0.20.5125Subdistribution hazard ratio (log scale) |
Mortality after ICI start · 1 month
| Comparison | HR | |
|---|---|---|
| ICI myotoxicity occurrence | 3.51 (95% CI 3.17–3.89) | |
| metastatic status | 1.55 (CI 1.52–1.58) | |
| 0.20.5125Hazard ratio (log scale) |
1-month fatality in ICI myotoxicity patients
| Comparison | Risk ratio | |
|---|---|---|
| severe arrhythmia | 1.64 (95% CI 1.03–2.61) | |
| heart failure | 1.49 (CI 1.06–2.07) | |
| respiratory failure | 1.50 (CI 1.05–2.15) | |
| 0.20.5125Risk ratio (log scale) |
- 1-month fatality in ICI myotoxicity patients — 1-month fatality
- 20.3%
ICI myocarditis and ICI myositis incidence
- Incidence range
- 0.3% and 0.6%
- Co-occurring
- ∼13%-23% of cases
Original publication
Incidence and risk factors of immune checkpoint inhibitor myocardial and muscle toxicity: a French nationwide study. Eur Heart J. Published 30 August 2025. doi:10.1093/eurheartj/ehaf682
Summarised from the published abstract; every number is checked against it