Cardiac troponin I elevation and overall survival among cancer patients receiving investigational compounds during phase I trials

Objective: To identify factors associated with troponin elevation and to measure the effect of elevated troponin on survival in cancer patients participating in phase I trials. Methods: Clinical characteristics, cardiovascular risk factors, and biological data from consecutive patients treated in phase I trials (January 2010-November 2012) were reviewed. Troponin value was measured for each patient before study-drug administration and then weekly. Cardiac troponin I was considered elevated if > 0.06 ng/mL. Incidence and relative risk of elevated troponin adjusted for potential confounding factors were estimated using multivariable Poisson regression models. A conditional Cox proportional hazards model was used to compare overall survival in patients with elevated troponin matched to patients without troponin elevation recruited in the same trial. Results: Of 463 patients, 42 (9%) experienced ≥ 1 episode of troponin I elevation after a median of 5 weeks (interquartile range: 3-13) from drug initiation. Crude incidence of troponin elevation was 36/1000 person-months (95% confidence interval [CI]: 25-47). Troponin elevation was more frequent in patients exposed to antiangiogenic compounds versus other treatments (relative risk: 1.9, 95% CI: 1.1-3.3). Median overall survival from drug initiation was 9 months (95% CI: 8-10), and 8 months (95% CI: 2-13) in patients with troponin elevation. In the case-control analysis, risk of death was higher in patients with troponin elevation (hazard ratio: 2.9, 95% CI: 1.2-6.8). Conclusion: Patients exposed to antiangiogenic compounds had a higher risk of troponin elevation, which was associated with a higher risk of death.