PD-1/PD-L1 Blockade Accelerates the Progression of Atherosclerosis in Cancer Patients

PD-1(programed death-1)/PD-L1(pro-gramed death-1 ligand) blockade represents a major breakthrough of anti-cancer therapies, however, it may come with increased risk of cardiovascular mor-bidity, such as myocarditis, acute coronary syndrome, arrhythmias, etc. Although the PD-1/PD-L1-blockade-related acute coronary syndrome (ACS) is rare, it can be fatal. Previous studies have implicated a role of the PD-1/PD-L1 axis in the development of atherosclero-sis. This review explores a hypothesis that PD-1/PD-L1 blockade accelerates the progression of atherosclerosis and promotes plaque rupture, by synthesizing the evidence of vascular inflammation, as well as plaque progression, destabilization and rupture via T-cell activation and effector function. In order to improve the prognosis of cancer patients and decrease the cardiotoxicity of PD-1/PD-L1 blockade therapy, early recognition of PD-1/PD-L1-blockade-related ACS is important. (Curr Probl Cardiol 2022;48:101527.)

Automated summary

PD-1/PD-L1 blockade is a significant breakthrough in anti-cancer therapies, but it may increase the risk of cardiovascular diseases. Previous studies have shown the involvement of the PD-1/PD-L1 axis in the development of atherosclerosis. This review explores the hypothesis that PD-1/PD-L1 blockade accelerates atherosclerosis progression and promotes plaque rupture, emphasizing the importance of early recognition of PD-1/PD-L1-blockade-related acute coronary syndrome.