Key result
Nivolumab therapy in a patient with metastatic melanoma and recent myocardial infarction was associated with rapidly progressive in-stent restenosis and severe worsening of coronary artery disease.
Why the study?
The association of the immune checkpoint inhibitor nivolumab with atherosclerotic disease has been rarely reported.
Does nivolumab therapy precipitate acute coronary syndrome or rapid progression of coronary artery disease in patients with prior MI?
Case Report (n=1)
Does nivolumab therapy precipitate acute coronary syndrome or rapid progression of coronary artery disease in patients with prior MI?
Nivolumab therapy may be associated with rapid progression of atherosclerotic disease and acute coronary syndrome, warranting close monitoring in susceptible patients.
May warrant surveillance for restenosis in post-MI patients on nivolumab; single case leaves open causal role and management implications.
INTRODUCTION: Immune checkpoint inhibitors (ICI) have led to improved survival in patients with a number of different tumor types. The ICI agent nivolumab induces anti-tumor immune responses by inhibiting the programmed cell death 1 protein, but side effects include cardiac immune-related adverse events (irAE) such as myocarditis.¹ The association of nivolumab with atherosclerotic disease has been rarely reported. CASE PRESENTATION: A 62-year-old man with metastatic melanoma and recent myocardial infarction (MI) presented with recurrent MI after having undergone several cycles of nivolumab therapy. Repeat cardiac catheterization revealed rapidly progressive in-stent restenosis and diffuse coronary artery disease (CAD) requiring bypass surgery and warranting cessation of nivolumab therapy. CONCLUSION: Nivolumab has been linked with dysregulation of immune responses including enhanced T cell activity, which is implicated in CAD. The timing of nivolumab therapy and presentation with non ST elevation myocardial infarction in this patient suggests a serious T cell-driven medication adverse effect. Therefore, close monitoring for atherosclerotic disease progression is warranted in patients on immunotherapy.
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Masson et al. (2020) conducted a case report in Metastatic melanoma and recent myocardial infarction (n=1). Nivolumab was evaluated on Development of recurrent myocardial infarction and rapidly progressive coronary artery disease. Nivolumab therapy in a patient with metastatic melanoma and recent myocardial infarction was associated with rapidly progressive in-stent restenosis and severe worsening of coronary artery disease.
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