Radiation-Induced Coronary Artery Disease During Immune Checkpoint Inhibitor Therapy: A Case Report

Abstract

Radiation-induced coronary artery disease (RICAD) poses a serious concern for cancer patients post radiotherapy, typically emerging after over a decade. Immune checkpoint inhibitors (ICIs), known for cardiotoxicity, are increasingly recognized for causing cardiovascular complications. Here we report the case of a 63-year-old man with metastatic lung cancer who developed coronary artery disease during his third-line therapy with an ICI (nivolumab) and an antiangiogenic agent (bevacizumab), 3 years post chest radiotherapy. Angiography revealed relatively isolated stenosis in the left main coronary artery ostium, consistent with the radiotherapy site, with no other risk factors, suggesting RICAD. The potential for ICIs to accelerate RICAD development should be considered and necessitates careful surveillance in patients receiving both radiotherapy and ICIs.

Plain language summary

Sometimes cancer patients receive a type of treatment called radiotherapy, which uses high-energy beams to target the cancer. This treatment is very helpful, but when applied to the chest, it can cause problems in the blood vessels of the heart many years later, a condition called radiation-induced heart disease. This report is about a 63-year-old man who developed this heart problem much sooner than usual, just 3 years after receiving radiation treatment for lung cancer. Alongside radiotherapy, he also received two advanced kinds of cancer treatments. One helped his immune system to better identify and fight the cancer, and the other worked to stop the cancer from getting the blood supply it needs to grow. Our report suggests that these new treatments may interact with radiotherapy in a way that causes heart problems more quickly. This is especially important to consider in patients without previous heart problems. Our findings remind doctors to closely monitor the heart health of patients receiving these treatments and point to the need for more research into how these treatments may affect the heart when used together.

Keywords::

• coronary artery disease
• heart diseases
• immune checkpoint inhibitors
• lung neoplasms
• radiotherapy

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/imt-2023-0084

Author contributions

X Qian contributed to investigation, data collection and drafting of the manuscript. K Ding contributed to the investigation and the verification of data. Y Lu contributed to critical revisions for intellectual content and gave final approval. All authors had final responsibility for the decision to submit for publication.

Acknowledgments

The authors would like to thank their colleagues at the Department of Radiation Oncology and wish to acknowledge the support provided by the Department of Cardiology at the Affiliated Lihuili Hospital, Ningbo University.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.