ArticlePloS one2025
The immune checkpoint inhibitor avelumab increases aortic inflammation on [18F]FDG PET/CT: A retrospective cohort study.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatients with cancer treated with immune checkpoint inhibitors (ICIs) are at increased risk of cardiovascular events. Preclinical studies suggest that this may result from inflammation-induced destabilization of atherosclerotic plaques.
objectiveTo evaluate changes in vessel wall inflammation assessed using [18F]FDG positron emission tomography/computed tomography (PET/CT) after ICI initiation.
methodsThis was a single-center retrospective cohort study of patients with Merkel cell carcinoma who received at least one cycle of the programmed death ligand 1 (PD-L1) inhibitor avelumab and underwent [18F]FDG PET/CT before initiation of treatment and after 3 months. The primary outcome was the change in the target-to-background ratio (TBRmax) in the descending aorta between baseline and first follow-up scan. Secondary outcomes included the change in TBRmax in the carotid arteries, spleen, and bone marrow, and incidence of major adverse cardiovascular events.
resultsFifty-three patients were included (66% male; median age 75 years). Most patients had established risk factors for cardiovascular disease (62%). The [18F]FDG TBRmax in the descending aorta increased from 1.52 (IQR, 1.39-1.70) at baseline to 1.64 (IQR, 1.41-1.97) after 3 months of treatment (change 7.8%. p = 0.022). No significant changes were observed in the carotid arteries, bone marrow, and spleen. Statin use was not associated with an attenuated change in TBRmax. During a median follow-up of 2.3 (IQR, 1.5-4.2) years, one nonfatal ischemic stroke occurred.
conclusionAvelumab treatment was associated with an increase in [18F]FDG uptake in the descending aorta after 3 months of treatment, which may be a potential marker of inflammation-driven accelerated atherosclerosis in patients receiving ICIs.
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