Dr. Raffaella Calabretta
MedUni Wien RESEARCHER OF THE MONTH December 2021
Besides typical cardiovascular risk factors, cardio-toxicity induced by antineoplastic drugs remains a critical issue. Cancer immunotherapy with immune checkpoint inhibitors (ICI), such as monoclonal antibodies targeting PD-1 (Nivolumab, Pembrolizumab), PD-L1 (Atezolizumab), or CTLA-4 (Ipilimumab), stimulate previously inactivated cytotoxic T-cells to recognize and target cancer cells. Interference with the CTLA-4 and PD-1 axes can cause immune-related adverse events, which in some cases leads to serious and potentially fatal cardiovascular toxicity. Previous studies suggested that PET/CT with 18[F] - Fluorodeoxyglucose (FDG) is a valid tool to quantify atherosclerotic inflammatory activity and predicted severe cardio- and cerebrovascular events in oncological patients.
20 patients with melanoma treated with ICI and available FDG PET/CT scans before and during/after treatment have been retrospectively analyzed. FDG maximum standardized uptake values (SUVmax) and SUVbloodpool for bloodpool correction of FDG were derived and target-to-background ratios (TBRs) were calculated. As surrogate markers of systemic immune cell activation, FDG uptake was also measured in bone marrow and in spleen before and after ICI therapy. Cancer immunotherapy with ICI resulted in a significant increase of arterial inflammatory activity. FDG uptake measured before and after ICI therapy in bone marrow and in spleen did not show statistical differences.
Significantly increasing FDG-uptake in the large arteries is pointing towards an induction of inflammatory activity after cancer immunotherapy with ICI and might cause increased cardio-/cerebrovascular complications.
Raffaella Calabretta, MD1, Christoph Hoeller2, MD, Verena Pichler, PhD1, Markus Mitterhauser, PhD1, Georgios Karanikas, MD1, Alexander Haug, MD1, Xiang Li, PhD1*, Marcus Hacker, MD1*
*shared last authorship
1 Division of Nuclear Medicine, Dept. of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria. 2 Department of Dermatology, Medical University of Vienna, Vienna, Austria.
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