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.
Keywords: coronary artery disease; heart diseases; immune checkpoint inhibitors; lung neoplasms; radiotherapy.
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.