Arterial inflammation on [18F]FDG PET/CT in melanoma patients treated with and without immune checkpoint inhibitors: CHECK-FLAME I

• Published in: Atherosclerosis Vol. 398; p. 118595
• Main Authors: Polomski, Elissa A.S., Kapiteijn, Ellen W., Heemelaar, Julius C., van der Kolk, Anne V., Kalisvaart, Timo M., van de Burgt, Alina, Dibbets-Schneider, Petra, van Velden, Floris H.P., Seijkens, Tom T.P., Stöger, J. Lauran, Jukema, J. Wouter, de Geus-Oei, Lioe-Fee, Antoni, M. Louisa
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2024
• Subjects: [18F]FDG PET/CT; Adult; Aged; Arteritis - chemically induced; Arteritis - diagnostic imaging; Arteritis - drug therapy; Cardio-oncology; Female; Fluorodeoxyglucose F18; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; Inflammation; Male; Melanoma - diagnostic imaging; Melanoma - drug therapy; Middle Aged; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Skin Neoplasms - diagnostic imaging; Skin Neoplasms - drug therapy; Skin Neoplasms - pathology; Time Factors; Treatment Outcome; Cardio-oncology; [18F]FDG PET/CT; Immune checkpoint inhibitors; Inflammation; [F]FDG PET/CT
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2024.118595

Immune checkpoint inhibitors (ICIs) revolutionized cancer treatment. However, ICIs may increase the immune response to non-tumor cells, possibly resulting in increased arterial inflammation, raising the risk of atherosclerotic events. Nevertheless, malignancies may induce a pro-inflammatory state and the association between ICIs and arterial inflammation remains to be clarified. This study aims to assess differences in increase in arterial inflammation between patients with advanced melanoma treated with ICIs compared to a control group without ICIs. Patients with advanced melanoma who underwent [18F]FDG PET/CT scans at baseline, 6 months (T1) and 18 months (T2) were included in this retrospective observational study. Arterial inflammation was evaluated in eight segments by calculating the target-to-background ratio (TBR). The primary study outcome was the difference in increase in mean TBRmax between patients treated with and without ICIs. We included 132 patients of whom 72.7 % were treated with ICIs. After exclusion for the use of anti-inflammatory medication, patients treated with ICIs showed a significant increase in mean TBRmax between baseline and T1 from 1.29 ± 0.12 to 1.33 ± 0.13 (p = 0.017), while in the control group, no change in mean TBRmax (1.30 ± 0.12 to 1.28 ± 0.10, p = 0.22) was observed (p = 0.027). During longer follow-up, mean TBRmax remained stable in both groups. Arterial inflammation increased significantly after ICI therapy in patients without active inflammation (p < 0.001) and in patients without calcifications (p = 0.013). A significant increase in arterial inflammation as measured on [18F]FDG PET/CT was observed in patients with advanced melanoma treated with ICIs only in the first six months after initiation of therapy, whereas no changes were observed in the control group. Moreover, arterial inflammation was mainly increased in patients without pre-existing inflammatory activity and with non-calcified lesions. [Display omitted] •Arterial inflammation increases in the first six months after initiation of ICI therapy in patients with advanced melanoma.•This may be associated with a higher risk of cardiovascular events in patients with ICI treatment.•The role of anti-inflammatory medication during ICI treatment should be evaluated, as this may reduce arterial inflammation.