Immune checkpoint inhibitors (ICIs) are a class of medications that are now standard in the treatment of melanoma. These are standard therapy for melanoma, but long-term side effects on disease in the heart arteries is poorly understood. In this study, melanoma patients receiving ICIs for the first time will undergo a coronary computed tomography angiography (CCTA) scan. CCTA results will be analyzed by the FDA-approved Cleerly TM image analysis pipeline. Patients with disease in their heart arteries will be randomized to usual care or aggressive lipid lowering therapy. Those in the aggressive lipid lowering therapy arm will be seen by a cardiologist and placed on standard lipid lowering medications with a goal of achieving an LDL-C ≤ 55mg/dL. Follow-up CCTA scans will occur at 12-month and 24-month timepoints. The primary outcome of interest will be differences in LDL-C levels between the two arms at the 12-month timepoint. The secondary outcome of interest will be the differences in total plaque volume between the two arms at the 12-month timepoint.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
40
Participants randomized to the aggressive lipid lowering therapy arm will receive Guideline-directed lipid-lowering therapy (statins and/or ezetimibe and/or PCSK9 inhibitors) managed by a cardiologist with dose adjustments to achieve LDL-C ≤55 mg/dL.
University of Colorado Hospital
Aurora, Colorado, United States
RECRUITINGMean change in LDL-C from baseline to 12 months
Each participant will have LDL-C measured prior to randomization and at the 12-month timepoint. The mean change in LDL-C (mg/dL) from baseline to 12 months will be calculated for each participant. The mean change will be compared between the aggressive lipid-lowering therapy arm and the usual care arm.
Time frame: Baseline to 12 months
Change in Total Plaque Volume from Baseline to 12 months
Each participant will have total plaque volume measured prior to randomization and at the 12-month timepoint via Cleerly TM's CCTA image analysis pipeline. The mean change in total coronary plaque volume (mm³), as measured by coronary computed tomography angiography (CCTA) using the Cleerly™ image analysis pipeline, from baseline to 12 months will be calculated for each participant and compared between study arms.
Time frame: 12 months
Major adverse cardiovascular events at 12 months
Major adverse cardiovascular events between 0 and 12 months will be noted to determine if there is a difference in major adverse cardiovascular events (MACE) rates between the usual care arm versus the aggressive lipid lowering arm.
Time frame: 12 months
Change in Calcified Plaque Volume from Baseline to 12 Months
Each participant will have proportion of calcified plaque volume measured prior to randomization and at the 12-month timepoint via Cleerly TM's CCTA image analysis pipeline. The difference between these two timepoints in each participant will be calculated to determine if there is a significant difference between proportion of calcified plaque volume changes in the usual care arm versus the aggressive lipid lowering arm.
Time frame: 12 months
Change in Size of the Largest Plaque from Baseline to 12 Months
Each participant will have the size of the largest plaque (by volume) measured prior to randomization and at the 12-month timepoint via Cleerly TM's CCTA image analysis pipeline. The difference between these two timepoints in each participant will be calculated to determine if there is a significant difference between largest plaque volume changes in the usual care arm versus the aggressive lipid lowering arm.
Time frame: 12 months
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