Abstract Body: Introduction:
Immune Checkpoint Inhibitors (ICIs) used for treatment of malignancies might promote atherosclerosis and increase the risk of ischemic stroke (IS). We aimed to compare IS characteristics of patients with non-small cell lung cancer (NSCLC) who received ICIs compared to those who did not. We hypothesized that IS associated with atherosclerosis will be more common among those treated with ICIs than other treatments.
Methods:
A retrospective single center study of patients,18 or older, with NSCLC presenting between 2013 and 2023, treated with either ICIs, chemotherapy, or a combination and had an IS any time following treatment. Patients without vessel imaging were excluded. We collected demographics and stroke characteristics. Two sample Mann-Whitney U and chi-square test were used to compare demographics and stroke etiologies among patients who received chemotherapy and those who received ICIs with or without chemotherapy.
Results:
A total of 58 patients were identified, 22 received chemotherapy only and 36 received ICIs. The mean age was 68.8, with 50% male (29/58). ICI treated groups had significantly more stage IV diagnoses (chemotherapy only 3.6%, ICI 67%, p=0.04). There was no difference in median time from treatment to stroke onset in days between groups; chemotherapy 90.5 (range 27-386) vs. ICI 337.5 (range 95-665), p= 0.39. The stroke etiology in those treated with chemotherapy alone were as follows: Large artery atherosclerosis (3), cardioembolic (8), small vessel disease (5), ESUS (5), other (1). For those treated with either ICI alone or ICI and chemotherapy: Large artery atherosclerosis (5), cardioembolic (6), small vessel disease (2), ESUS (23), other (0). Stroke etiology consistent with embolic stroke with unknown source (ESUS) was more common in the ICI group (chemotherapy only 2.3%, ICI 64%, p=0.02).
Conclusions:
Contrary to prior research suggesting atherogenesis with ICI, the most common stroke etiology in the ICI group was ESUS.