In July 2021, this group completed enrollment for STOP-CA. STOP-CA is funded by the National Heart, Lung, and Blood Institute (R01HL130539) and is an investigator-initiated double-blind placebo controlled clinical trial testing whether statin therapy is associated with preservation of cardiac function (LV EF by cardiac MRI) among patients with lymphoma. Other endpoints include cardiac fibrosis by MRI, global longitudinal strain by echocardiography and serum biomarkers.
The treatment of patients with cancer has evolved and continues to evolve. Immune checkpoint inhibitors (ICI’s) represent a paradigm shift in the care of patients with cancer. They leverage the remarkable power of the immune system to target and kill cancer cells (Figure, Zhang, Neilan, JACC CO, 2020). In brief, cancer cells escape immune recognition by triggering the overexpression or activation of inhibitor checkpoint pathways. These pathways include those that block programmed death receptor 1 (PD-1), programmed death receptor 1 ligand (PD-L1) or cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Immune checkpoint inhibitors are monoclonal antibodies (e.g., anti-PD-1, anti-PD-L1 and anti-CTLA-4) that block this process, thus activating T cells and initiating an adaptive immune response, allowing the immune system to recognize abnormal cancerous cells.
However, work from CIRC and others has highlighted how ICIs are also associated with both acute and chronic adverse effects on the cardiovascular system. Acutely, these ICIs are associated with an acute and fulminant myocarditis (Mahmood, JACC, 2018) , an increase in arrythmias (D’Souza, EHJ, 2021), and pericardial disease (Gong, JITC, 2021). Sub-acutely, a collaboration within CIRC, showed that these ICIs are associated with a 3-fold increase in progression of atherosclerosis (Drobni, Circulation, 2020) using CT and parallel 3-fold increase in atherosclerotic-related cardiovascular events (Drobni, Circulation, 2020).