Clinical Scorecard: Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Cancer Patients with Type 2 Diabetes Experiencing Immune Checkpoint Inhibitor-Related Cardiotoxicity: A Retrospective Study

At a Glance

Key Highlights

• SGLT2 inhibitor use was independently associated with reduced all-cause mortality in cancer patients with T2DM and established iRCs (adjusted HR = 0.520, p = 0.033).
• Patients treated with SGLT2 inhibitors showed lower incidence of high-grade iRCs (19.2% vs. 45.8%, p = 0.031) and longer median survival (743 vs. 494 days).
• Although MACE incidence differences were not statistically significant, trends favored SGLT2i use with a 47% lower risk of MACE observed in univariate analysis.

Guideline-Based Recommendations

Diagnosis

• Diagnose iRCs according to 2022 European Society of Cardiology Cardio-Oncology Guidelines and IC-OS Consensus Statement.
• Confirm iRCs diagnosis with multidisciplinary evaluation by cardiologists and oncologists.

Management

• Current management of iRCs relies primarily on acute-phase immunosuppressive therapies such as glucocorticoids.
• No specific guideline recommendations exist for glucose-lowering agents in cancer patients with T2DM and iRCs.
• Consider SGLT2 inhibitors for potential cardioprotective and oncologic benefits in this high-risk population, pending prospective validation.

Monitoring & Follow-up

• Monitor cardiac function and severity of iRCs during and after ICI therapy.
• Assess for major adverse cardiovascular events (MACE) in patients with T2DM receiving ICIs.

Risks

• Be aware of the life-threatening nature of iRCs with rapid progression and high mortality.
• Recognize that T2DM increases risk and severity of iRCs and worsens outcomes.

Patient & Prescribing Data

Cancer patients with type 2 diabetes mellitus who developed immune checkpoint inhibitor-related cardiotoxicity during ICI therapy.

SGLT2 inhibitor use prior to iRCs onset is associated with improved survival, reduced severity of cardiotoxicity, and favorable trends in cardiovascular event reduction.

Clinical Best Practices

• Integrate multidisciplinary evaluation for diagnosis and management of iRCs in cancer patients with T2DM.
• Consider early initiation of SGLT2 inhibitors in eligible patients to potentially improve cardioprotective and oncologic outcomes.
• Closely monitor cardiac status and adverse events during ICI therapy, especially in patients with T2DM.
• Recognize the need for prospective studies to confirm benefits of SGLT2 inhibitors in this population.

Related Resources & Content

• 2022 European Society of Cardiology Cardio-Oncology Guidelines
• Perelman et al. Retrospective Study on SGLT2i and Mortality in T2DM Patients Receiving ICIs