51
|
Poels K, Neppelenbroek SIM, Kersten MJ, Antoni ML, Lutgens E, Seijkens TTP. Immune checkpoint inhibitor treatment and atherosclerotic cardiovascular disease: an emerging clinical problem. J Immunother Cancer 2021; 9:e002916. [PMID: 34168005 PMCID: PMC8231062 DOI: 10.1136/jitc-2021-002916] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
Antibody-mediated blockade of co-inhibitory molecules such as cytotoxic T lymphocyte-associated protein 4, PD1 and PDL1 elicits potent antitumor responses and improves the prognosis of many patients with cancer. As these immune checkpoint inhibitors (ICIs) are increasingly prescribed to a diverse patient population, a broad range of adverse effects is emerging. Atherosclerosis, a lipid-driven chronic inflammatory disease of the large arteries, may be aggravated by ICI treatment. In this review, we discuss recent clinical studies that analyze the correlation between ICI use and atherosclerotic cardiovascular disease (CVD). Indeed, several studies report an increased incidence of atherosclerotic CVD after ICI administration, with the occurrence of pathologies such as myocardial infarction, ischemic stroke and coronary artery disease significantly higher after ICI use. Increased awareness and better monitoring of ICI-treated patients can elucidate risk factors that contribute to ICI-induced aggravation of atherosclerosis and identify promising treatment strategies. For now, optimal cardiovascular risk assessment is required to protect ICI-receiving patients and long-term survivors of cancer from the detrimental effects of ICI therapy on atherosclerotic CVD.
Collapse
Affiliation(s)
- Kikkie Poels
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanne I M Neppelenbroek
- Department of Psychosocial Research and Epidemiology (PSOE), Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, Cancer Center Amsterdam and LYMMCARE, Amsterdam, Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, Cancer Center Amsterdam and LYMMCARE, Amsterdam, Netherlands
| | - M Louisa Antoni
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther Lutgens
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
- Institute for Cardiovascular Prevention (IPEK), Ludwig Maximilian's University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tom T P Seijkens
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, Cancer Center Amsterdam and LYMMCARE, Amsterdam, Netherlands
- Department of Medical Oncology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, Netherlands
| |
Collapse
|
52
|
Inno A, Chiampan A, Lanzoni L, Verzè M, Molon G, Gori S. Immune Checkpoint Inhibitors and Atherosclerotic Vascular Events in Cancer Patients. Front Cardiovasc Med 2021; 8:652186. [PMID: 34124192 PMCID: PMC8193098 DOI: 10.3389/fcvm.2021.652186] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
In clinical trials and meta-analysis, atherosclerotic vascular events (AVEs) during treatment with immune-checkpoint inhibitors (ICIs) have been reported with low incidence. However, preclinical data suggest that these drugs can promote atherosclerosis inflammation and progression of atherosclerosis plaques, and there is now growing and convincing evidence from retrospective studies that ICIs increase the risk of atherosclerotic vascular events including arterial thrombosis, myocardial infarction and ischemic stroke. Prospective studies are needed to increase knowledge on long-term effect of ICIs or their combinations with other cardio-toxic drugs, but in the meantime a careful assessment and optimization of cardiovascular risk factors among patients treated with ICIs is advisable.
Collapse
Affiliation(s)
- Alessandro Inno
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Andrea Chiampan
- Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Laura Lanzoni
- Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Matteo Verzè
- Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Giulio Molon
- Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Stefania Gori
- Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Sacro Cuore Don Calabria, Verona, Italy
| |
Collapse
|
53
|
Petrelli F, Solinas C. Reply to the letter to the editor 'Reply to Solinas et al, venous and arterial thromboembolic events with immune checkpoint inhibitors: A systematic review' by Frere et al. Thromb Res 2021; 208:217-218. [PMID: 33810866 DOI: 10.1016/j.thromres.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Cinzia Solinas
- Azienda Tutela della Salute Sardegna, Medical Oncology, Nuoro, Italy
| |
Collapse
|
54
|
Frere C, Ederhy S, Salem JE. Letter to the editors-in-chief reply to: Solinas et al. Venous and arterial thromboembolic events with immune check point inhibitors: A systematic review. Thromb Res 2021; 208:214-216. [PMID: 33678421 DOI: 10.1016/j.thromres.2021.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Corinne Frere
- Sorbonne Université, UNICO-GRECO Cardio-Oncology Program, INSERM UMRS_1166, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Stéphane Ederhy
- Sorbonne Université, UNICO-GRECO Cardio-Oncology Program, INSERM UMRS_1166, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Cardiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, UNICO-GRECO Cardio-Oncology Program, INSERM UMRS_1166, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
55
|
Kewan T, Ko T, Flores M, Sallam Y, Haddad A, Daw H. Prognostic impact and risk factors of cancer-associated thrombosis events in stage-IV cancer patients treated with immune checkpoint inhibitors. Eur J Haematol 2021; 106:682-688. [PMID: 33565130 DOI: 10.1111/ejh.13598] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer-associated thrombosis (CAT) is a major cause of mortality in cancer patients. Immune checkpoint inhibitors (ICIs) have been associated with multiple side effects including CAT. The aim of this study is to investigate risk factors and prognostic impact associated with CAT events during ICIs treatment. METHODS This is a multi-center retrospective study that included stage IV cancer patients treated with ICIs. RESULTS We identified 552 cancer patients treated with ICIs. During follow-up time, 58 (10.5%) patients developed 67 venous thromboembolism (VTE) events while on ICIs. Anticoagulation use at the time of ICIs treatment start was associated with significantly higher VTE incidence rate (IRR: 2.23). No significant difference in VTE IRR was observed depending on response to ICIs treatment, aspirin use, or Khorana VTE risk score. Melanoma as primary cancer, Khorana score, ECOG status, and anemia at baseline were able to predict mortality. CONCLUSIONS The incidence of CAT in stage-IV cancer patients treated with ICIs was higher in our study compared to previous reports. Control group of patients who did not receive ICIs is needed for better identification of CAT risk factors. Khorana score was a good predictor of mortality but not CAT risk and needs to be further validated in a homogenous group of patients.
Collapse
Affiliation(s)
- Tariq Kewan
- Departement of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | - Taeyeong Ko
- Departement of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | - Monica Flores
- Departement of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | - Yacoub Sallam
- Departement of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | - Abdo Haddad
- Departement of Hematology and Oncology, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | - Hamed Daw
- Departement of Hematology and Oncology, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| |
Collapse
|
56
|
Grover SP, Hisada YM, Kasthuri RS, Reeves BN, Mackman N. Cancer Therapy-Associated Thrombosis. Arterioscler Thromb Vasc Biol 2021; 41:1291-1305. [PMID: 33567864 DOI: 10.1161/atvbaha.120.314378] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Steven P Grover
- UNC Blood Research Center, Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill
| | - Yohei M Hisada
- UNC Blood Research Center, Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill
| | - Raj S Kasthuri
- UNC Blood Research Center, Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill
| | - Brandi N Reeves
- UNC Blood Research Center, Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill
| | - Nigel Mackman
- UNC Blood Research Center, Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill
| |
Collapse
|