Immune Checkpoint Inhibitor Therapy and Cardiovascular Health: A Case Report

Introduction Immune checkpoint inhibitors (ICIs) have significantly improved cancer management by enhancing antitumor immune responses [1]. Despite it being effective, the use of ICIs is associated with rare, immune-related adverse events (irAE), including the cardiovascular (CV) systems, specifically myocarditis and accelerated atherosclerosis [1][2]. This case demonstrates the development of significant coronary artery disease in a patient undergoing long-term ICI therapy for metastatic melanoma. Case Presentation A 65-year-old female was presented to the outpatient Cardiology department with an episode of epigastric pain radiating to the neck during the night, lasting approx. 5 minutes (2023 Nov 11). Past medical history included arterial hypertension, managed with antihypertensive therapy for 15 years, hypercholesterolemia, treated with statins, and malignant melanoma, diagnosed in 2013. The diagnosis of metastatic melanoma, prompted the initiation of immunotherapy with nivolumab in 2020. Since it's linked with irAE, troponin I was evaluated and was found to be within normal limits, reducing the likelihood of myocarditis. Additionally, coronary computed tomography angiography, and later invasive coronary angiography, was performed revealing stenoses in the coronary arteries segments: right proximal, medial - 35; left main - 25; LAD proximal - 75; Cx medial - 80. The patient was subsequently admitted to the Cardiology Department for planned percutaneous coronary intervention. Critical stenoses in LAD medial and Cx medial were treated with stent implantation. Discussion CV adverse events are recognized as a serious complication with the increasing use of ICIs. Although the mechanisms are not fully understood, it is hypothesized that ICIs induce a T cell-mediated inflammatory response, which may lead to the progression of atherosclerosis and plaque instability [3]. Therefore assessing CV risk factors through medical history and physical examination is important before and after initiation of ICI therapy [3]. Conclusions This case highlights the importance of CV monitoring in patients receiving ICIs, particularly those with pre-existing CV risk factors. Multidisciplinary care remains pivotal in optimizing outcomes for patients with concomitant oncologic and CV conditions.