Baseline selective beta-1 blocker therapy may be an independent predictor of increased all-cause mortality in patients treated with immune checkpoint inhibitors, although it was not an independent predictor of cardiovascular immune-related adverse events.
In a retrospective single-center cohort of 2409 ICI-treated cancer patients, 25% were pretreated with a selective beta-1 blocker (β1B).
Patients in the β1B group were older and had a higher prevalence of cardiac risk factors and cardiovascular disease than those not on β1B.
Unadjusted all-cause mortality was higher in patients pretreated with β1B.
Unadjusted rates of CV irAEs were higher in the β1B group, mainly heart failure and atrial fibrillation.
In multivariate analysis, β1B remained an independent predictor of all-cause mortality.
β1B was not an independent predictor of CV irAEs after multivariate adjustment.
The association between baseline β1B treatment and increased all-cause mortality was consistent regardless of baseline cardiovascular disease.
The authors conclude that baseline β1B therapy may be an independent predictor of increased all-cause mortality in ICI-treated patients.
This study looked at 2,409 patients with cancer who were treated with immune checkpoint inhibitors, a type of immunotherapy. About one in four were already taking a selective beta-1 blocker, a heart medication, before starting treatment. These patients were older and much more likely to have heart disease, such as coronary disease, heart failure, or atrial fibrillation. Patients on beta-1 blockers were more likely to die during follow-up (68% vs. 57%) and had more heart-related immune side effects (14% vs. 7%). After accounting for other differences between the groups, taking a beta-1 blocker was still linked to a modestly higher risk of death (hazard ratio 1.21). The higher rate of heart-related immune side effects was no longer significant after adjustment. The link with death was similar in patients with and without heart disease. This research suggests that selective beta-1 blocker use may be a marker of worse outcomes in people receiving immunotherapy, unlike earlier findings for non-selective beta-blockers. Because this was a retrospective, single-center study, it cannot show that the drugs themselves cause worse outcomes. Patients taking them may differ in ways the analysis could not fully capture. Further research is needed to understand the relationship.
Perelman M, Brzezinski R, Gefen S, Merin R, Miodovnik M, Raphael A, et al.. (2026). Prognostic role of selective beta-1 blockers in patients treated with immune checkpoint inhibitors.. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.1007/s00520-026-11366-7