Longitudinal Assessment of Subclinical Arterial Inflammation in Patients Receiving Immune Checkpoint Inhibitors by Sequential [ 18 F]FDG PET Scans
Authors' conclusion
This is the first controlled clinical study supporting the role of ICIs in accelerating atherosclerosis through low-grade arterial inflammation. However, although detectable by repeated [ 18 F]FDG scans, the increase in tracer uptake associated with ICI use was modest compared with individual variability, questioning whether [ 18 F]FDG captures the full pathophysiological process of ICI-induced, lymphocyte-driven inflammation.
Study context
- Population
- Patients with cancer aged ≥65 years with at least 4 sequential [ 18 F]FDG PET scans within 30 months, treated at a German University Hospital between January 2010 and May 202350 (30.1%) received immune checkpoint inhibitors (ICIs) after the baseline scan
- Participants
- 156 patients
- Comparison
- Change in arterial tracer uptake in patients who received ICI or not
- ICI usersn = 50
- Outcome
- Baseline arterial [ 18 F]FDG uptake and cardiovascular risk factors
- Follow-up
- Baseline
Methodological detailsserial positron emission tomography scans, linear mixed regression analyses, German University Hospital
- Serial positron emission tomography scans
- Linear mixed regression analyses
- German University Hospital
Main finding
As reported in the abstract
- Baseline arterial [ 18 F]FDG uptake correlated with traditional cardiovascular risk factors, such as body mass index and male sex
Further findings
Annual increase
| Outcome | ICI users | No ICI | P value |
|---|---|---|---|
| Annual change in arterial [ 18 F]FDG uptake · annuallyTime-dependent interaction analysis | 2.5% (95% CI 1.7%–3.3%) | 0.8% (95% CI 0.2%–1.4%) | P = 0.001 |
- Annual change in arterial [ 18 F]FDG uptake: time-dependent interaction analysis; higher annual increase in ICI users
Cholesterol-lowering medication and arterial [ 18 F]FDG uptake · follow-up
- Cross-sectional analyses suggested a negative effect of cholesterol-lowering medication on arterial [ 18 F]FDG uptake
Annual increase in ICI users by subgroup
- Higher annual increase rates in ICI users were consistent across several anatomic landmarks, preexisting cardiovascular disease status, arterial calcification status, and concomitant chemotherapy or steroid use
- This effect did not reach statistical significance in patients with melanoma and those with prior irradiation therapy
Original publication
Longitudinal Assessment of Subclinical Arterial Inflammation in Patients Receiving Immune Checkpoint Inhibitors by Sequential [ 18 F]FDG PET Scans. Circ Cardiovasc Imaging. Published 4 February 2025. doi:10.
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