Immune checkpoint inhibitor (ICI) therapy may increase the risk of major atherosclerotic cardiovascular events (MACE) in patients with high-risk or advanced melanoma, according to a study published in Cardio-Oncology.

This retrospective cohort study enrolled patients with stage II, III, or IV melanoma who presented to an academic tertiary hospital in Victoria, Australia from 2015 through 2020.

The study cohort comprised 646 patients, of whom 289 had been treated with ICI. Baseline demographic characteristics were comparable between treatment groups. The median age was 67.9 years in the ICI-treated group and 66.1 years in the non-ICI treated group. Men comprised a greater percentage of the ICI group than the non-ICI group (72.0% vs 62.5%; P =.01). Melanoma characteristics, including cancer stage and histologic subtype, were similar between the groups.

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The outcome of interest was MACE, which included acute myocardial infarction, ischemic stroke, acute limb ischemia, and coronary or other arterial revascularization procedure. Potential MACE events were identified from imaging reports, hospital discharge summaries, or cause of death certificates.

A total of 29 cardiovascular events were observed in 23 patients, including 22 events in the ICI group. The incidence of MACE was higher in the ICI vs non-ICI group (3.6 vs 0.9 events per 100 person-years).

In an analysis adjusted for age, sex, smoking history, and previous exposure to BRAF and/or MEK inhibitors, ICI treatment was associated with an increased risk of MACE (hazard ratio [HR], 2.8; 95% CI, 1.1-6.9; P =.03). Among patients with a past history of MACE, ICI treatment conferred a particularly elevated risk of MACE (HR, 14.4; 95% CI, 1.9-112.3; P =.01).

“Our real world study confirms an association between major atherosclerotic cardiovascular events and ICI treatment in a population of high-risk and advanced melanoma patients,” the study authors wrote. “As such, melanoma clinicians should consider risk factor modification and/or cardiovascular screening prior to ICI commencement in these individuals.”

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Wang C, Zoungas S, Yan M, et al. Immune checkpoint inhibitors and the risk of major atherosclerotic cardiovascular events in patients with high-risk or advanced melanoma: a retrospective cohort study. Cardiooncology. 2022;8(1):23. doi:10.1186/s40959-022-00149-8

This article originally appeared on Dermatology Advisor