MANAGEMENT OF IMMUNOTHERAPY IN CANCER PATIENTS WITH ATHEROSCLEROSIS–RELATED ACUTE CORONARY SYNDROME

Abstract Background There‘s increasing evidence on the possible pro–atherogenic side effect of immune checkpoint inhibitors (ICIs) leading to an increased risk of atherosclerotic cardiovascular disease (ASCVD) in long–term treated patients. Methods We retrospectively collected data on acute coronary syndrome (ACS) in active cancer patients receiving ICIs for more than 6 months in 2023. Any baseline information on cancer site, type of ICIs, treatment–line as well as ACS diagnosis, management, outcome and physician attitude towards ICIs was recorded. Results Ten patients were identified (8/2 M/F; median age 74[70–81]years; lung cancer as prevalent site; ICIs as first–line treatment mainly). Most frequent cardiovascular risk factors included hypertension (70%), smoking (70%), lipids disorders (30%) and diabetes (20%). 3/10 pts presented with STEMI, 5/10 with NSTEMI and 2/10 with unstable angina. All pts underwent coronary angiography with 9/10 PTCA stent (1 MINOCA) with no procedure–related complications plus guideline–oriented medical therapy. 8/10 pts restarted ICIs one months after ACS; in two patients immunotherapy was stopped due to oncologist decision (planned stop after 2yrs of treatment with disease control). No cardiovascular issues were recorded after ICIs re–start at one year follow–up. Conclusions Immunotherapy resumption after ICIs–related ASCVD appears to be safe with no new ACS episodes. Further prospective confirmation on a larger sample size is needed.