Ipilimumab-nivolumab therapy causing STEMI in a melanoma patient: A case report

Abstract

The combination of ipilimumab and nivolumab has shown great promise in improving survival in patients with advanced melanoma. However, these novel agents are not without side effects, with adverse events occurring in up to 55% of patients on combination therapy. We report a case of ST-elevation myocardial infarction (STEMI) with resultant new severe systolic heart failure and left ventricular thrombus in a middle-aged woman with metastatic melanoma on ipilimumab-nivolumab therapy suspicious for de novo intra-arterial thrombus formation. We hypothesize that this is likely due to an immune-related adverse event, a documented phenomenon in patients on this combination therapy. To the best of our knowledge, this is the first case in patients on ipilimumab-nivolumab therapy to develop STEMI due to intra-arterial thrombus formation.

Immune checkpoint inhibitors and potential risk of thromboembolic events: Analysis of the WHO global database of individual case safety reports

“…Overall, the results of this study align with those from prior studies documenting the increased risk of VTE and ATE events associated with the use of ICIs. (“ Abstracts of 48th ESCP symposium on clinical pharmacy 23–25 October 2019 , Ljubljana (Slovenia),” 2020; Alkhathlan et al, 2017 , Ferreira et al, 2018 , Kunimasa et al, 2018 , Li et al, 2021 , Sussman et al, 2021 , Tomita et al, 2017 , Tsukamoto et al, 2018 ) In terms of confounding factors, it has been argued that gender and age may increase the risk of thromboembolism in patients receiving ICIs. One study found that the event rate was higher in patients ≥ 65 years of age compared to younger patients and in male patients (59%) compared to female patients (41%).…”