Among 2,069 lung cancer patients with cardiac biomarker data drawn from a 2018–2024 Renji Hospital cohort, 15.8% (326 patients) developed cardiotoxicity after receiving any of 82 targeted anticancer agents. PD-1 inhibitors carried the highest adjusted hazard (HR 1.81, 95% CI 1.43–2.28), followed by VEGF inhibitors (HR 1.33, 95% CI 1.06–1.67). Critically, PD-1 inhibitor cardiac risk followed a nonlinear exposure-response curve, rising sharply through approximately four administrations and plateauing near a cumulative dose of 780 mg — a finding corroborated by FDA FAERS disproportionality signals across 4,249 cardiac adverse events.
This preprint, not yet peer-reviewed, adds meaningful real-world granularity to a concern that has been building since checkpoint inhibitors entered standard oncology practice. Immune-mediated myocarditis from PD-1 blockade, though historically reported at under 1–2% in trial populations, may be substantially underdetected in routine care where serial cardiac biomarker monitoring is inconsistent. The nonlinear dose-response inflection point is particularly actionable: it suggests a high-vigilance window early in treatment cycles rather than a cumulative-dose model. The VEGF inhibitor signal is consistent with known hypertensive and vascular mechanisms. Limitations include single-center retrospective design, potential biomarker ascertainment bias, and an incomplete abstract truncating key sensitivity analysis results. Clinicians managing lung cancer patients on immunotherapy should consider protocolized early biomarker surveillance, especially within the first four treatment cycles. An incremental but clinically useful contribution pending peer review.