TY - JOUR
T1 - Immune checkpoint inhibitors and the risk of major atherosclerotic cardiovascular events in patients with high-risk or advanced melanoma
T2 - a retrospective cohort study
AU - Wang, Charlie
AU - Zoungas, Sophia
AU - Yan, Mabel
AU - Wolfe, Rory
AU - Haydon, Andrew
AU - Shackleton, Mark
AU - Voskoboynik, Mark
AU - Moore, Maggie
AU - Andrews, Miles C.
AU - Nicholls, Stephen J.
AU - Mar, Victoria
N1 - Funding Information:
There was no direct funding for this study. CW and MY are both supported by an Australian Government Research Training Program Scholarship. MS was supported by a Victorian Cancer Agency Fellowship.
Funding Information:
SZ – No personal conflicts of interest. Her institution (Monash University) receives funding from NHMRC, MRFF, Victorian Department of Health and Human Services, as well as Eli Lilly Australia Ltd., Boehringer-Ingelheim, MSD Australia, Astra Zeneca, Novonordisk, Sanofi and Servier for unrelated work.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Immune checkpoint inhibitors (ICI) are associated with immune-mediated adverse effects, potentially involving any organ. ICI has also been associated with an increased risk of cardiovascular disease in cancer populations. Objective: To characterize the incidence and risk of major atherosclerotic cardiovascular events associated with ICI use in a high-risk and advanced melanoma population. Methods: We conducted a retrospective cohort study of patients with high-risk or advanced melanoma (AJCC stage II, III or IV) presenting to an academic tertiary hospital between 2015–2020. The main outcome was major atherosclerotic cardiovascular events (MACE) including acute myocardial infarction, ischemic stroke, acute limb ischemia and coronary revascularization. Results: The study cohort consisted of 646 patients, including 289 who had been treated with ICI. The incidence of MACE was higher in the ICI treated group (3.6 vs. 0.9 events per 100-person years). After adjusting for age, sex, smoking history and prior BRAF and/or MEK inhibitor use, ICI treatment was associated with an increased risk of MACE (HRadj 2.8, 95% CI 1.1–6.9, p = 0.03). Elevated risk was especially pronounced in patients with a past history of MACE (HR 14.4, 95% CI 1.9–112.3, p = 0.01). Conclusion: Patients with high-risk or advanced melanoma are at an increased risk of atherosclerotic cardiovascular events following ICI treatment, particularly those with a history of cardiovascular disease.
AB - Background: Immune checkpoint inhibitors (ICI) are associated with immune-mediated adverse effects, potentially involving any organ. ICI has also been associated with an increased risk of cardiovascular disease in cancer populations. Objective: To characterize the incidence and risk of major atherosclerotic cardiovascular events associated with ICI use in a high-risk and advanced melanoma population. Methods: We conducted a retrospective cohort study of patients with high-risk or advanced melanoma (AJCC stage II, III or IV) presenting to an academic tertiary hospital between 2015–2020. The main outcome was major atherosclerotic cardiovascular events (MACE) including acute myocardial infarction, ischemic stroke, acute limb ischemia and coronary revascularization. Results: The study cohort consisted of 646 patients, including 289 who had been treated with ICI. The incidence of MACE was higher in the ICI treated group (3.6 vs. 0.9 events per 100-person years). After adjusting for age, sex, smoking history and prior BRAF and/or MEK inhibitor use, ICI treatment was associated with an increased risk of MACE (HRadj 2.8, 95% CI 1.1–6.9, p = 0.03). Elevated risk was especially pronounced in patients with a past history of MACE (HR 14.4, 95% CI 1.9–112.3, p = 0.01). Conclusion: Patients with high-risk or advanced melanoma are at an increased risk of atherosclerotic cardiovascular events following ICI treatment, particularly those with a history of cardiovascular disease.
UR - http://www.scopus.com/inward/record.url?scp=85143334001&partnerID=8YFLogxK
U2 - 10.1186/s40959-022-00149-8
DO - 10.1186/s40959-022-00149-8
M3 - Article
C2 - 36461057
AN - SCOPUS:85143334001
SN - 2057-3804
VL - 8
JO - Cardio-Oncology
JF - Cardio-Oncology
IS - 1
M1 - 23
ER -
