Immune Checkpoint Inhibitor Therapy and Acute Coronary Syndrome: A Review of Mechanisms and Management

Immune checkpoint inhibitor (ICI) therapy is a class of immune-activating therapies that has revolutionized the treatment of various cancers over the past decade. With expanding clinical indications of this drug class, understanding the short-term and long-term implications of checkpoint inhibitor therapy has grown in importance. Numerous reports have highlighted potential inflammatory adverse effects, including cardiotoxicity. Efforts to characterize cardiovascular adverse events, however, have largely focused on myocarditis with emerging evidence demonstrating the association between ICI therapies and atherosclerotic cardiovascular disease. Given the inherently higher risk of thrombosis and bleeding in patients with cancer, the safe and effective management of ICI-associated acute coronary syndrome remains a therapeutic challenge requiring a tailored and multidisciplinary approach. In this review, we discuss the pathophysiology of ICI-associated atherosclerosis, the complexities of acute coronary syndrome management in patients with cancer, and the opportunities for risk prevention in patients receiving ICI therapies.