Immune checkpoint inhibitor-associated myocardial infarction in a patient with lung cancer undergoing six cycles of immunotherapy: a case report

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of patients with lung cancer, including improving their survival rates. Immune checkpoint inhibitor-associated myocardial infarction is a rare but serious complication of using ICIs. We here present a case of a 70-year-old man who developed ICI-associated myocardial infarction, underwent percutaneous coronary stent implantation, and subsequently received standard oral medication. Chemotherapy was resumed after tumor progression was identified, at which time a review of coronary computed tomography angiography showed no stent stenosis. Strengthening the education and supervision of patients with cancer receiving ICIs and identifying and managing ICI-associated atherosclerosis in a timely manner is therefore necessary.

Keywords

Immune checkpoint inhibitors / Myocardial infarction / Percutaneous coronary stent implantation / Medical and Health Sciences / Cardiorespiratory Medicine and Haematology / Oncology and Carcinogenesis

References

[1] LarkinJ, Chiarion-SileniV, GonzalezR, et al. . Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med, 2019, 381161535-1546.

[2] PostowMA, SidlowR, HellmannMD. Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med, 2018, 3782158-168.

[3] DrobniZD, AlviRM, TaronJ, et al. . Association between immune checkpoint inhibitors with cardiovascular events and atherosclerotic plaque. Circulation, 2020, 142242299-2311.

[4] LouL, DeteringL, LuehmannH, et al. . Visualizing immune checkpoint inhibitors derived inflammation in atherosclerosis. Circ Res, 2024, 13510990-1003.

[5] PoelsK, NeppelenbroekS, KerstenMJ, et al. . Immune checkpoint inhibitor treatment and atherosclerotic cardiovascular disease: an emerging clinical problem. J Immunother Cancer, 2021, 96e002916.

[6] ShieldsMD, ChiangAC, ByersLA. Top advances of the year: small cell lung cancer. Cancer, 2025, 1316e35770.

[7] LimJU, RyuWK, ParkN, et al. . Current and future perspectives in extensive-stage small-cell lung cancer. Ther Adv Med Oncol, 2025, 17: 17588359251326705.

[8] ZhangS, ChengY. Immunotherapy for extensive-stage small-cell lung cancer: current landscape and future perspectives. Front Oncol, 2023, 13: 1142081.

[9] PalaskasNL, AliHJ, KoutroumpakisE, et al. . Cardiovascular toxicity of immune therapies for cancer. BMJ, 2024, 385: e075859.

[10] ThunyF, NaidooJ, NeilanTG. Cardiovascular complications of immune checkpoint inhibitors for cancer. Eur Heart J, 2022, 43424458-4468.

[11] LutgensE, MulderW. CHECKPOINT ATHERO: developing immune checkpoint-based therapeutics for atherosclerosis. Eur Heart J, 2023, 44121010-1012.

[12] MoslehiJJ. Cardio-oncology: a new clinical frontier and novel platform for cardiovascular investigation. Circulation, 2024, 1507513-515.

[13] MunirAZ, GutierrezA, QinJ, et al. . Immune-checkpoint inhibitor-mediated myocarditis: CTLA4, PD1 and LAG3 in the heart. Nat Rev Cancer, 2024, 248540-553.

[14] LyonAR, López-FernándezT, CouchLS, et al. . 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J, 2022, 43414229-4361.

[15] PoelsK, van LeentM, BoutrosC, et al. . Immune checkpoint inhibitor therapy aggravates T cell-driven plaque inflammation in atherosclerosis. JACC CardioOncol, 2020, 24599-610.

Funding

Innovative Research Group Project of the National Natural Science Foundation of China(82170359)

Innovative Research Group Project of the National Natural Science Foundation of China(82470354)

National Major Science and Technology Projects of China(2023ZD0502800)

Shanghai Shenkang Hospital Development Center(SHDC22023207)

RIGHTS & PERMISSIONS

The Author(s)