Durable complete response to tislelizumab in advanced pMMR cervical cancer and successful rechallenge after immune-related NSTEMI: a case report

Background Immune checkpoint inhibitors (ICIs) have substantially improved long-term oncologic outcomes in patients with advanced malignancies; however, ICI-related cardiovascular adverse events have emerged as a growing clinical challenge. Accumulating clinical evidence confirms that ICI treatment markedly increases the risk of atherosclerotic cardiovascular disease (ASCVD). Although cardiovascular toxicities secondary to ICIs are relatively infrequent, these complications carry severe and potentially fatal clinical consequences. Herein, we describe a rare case of acute non-ST-segment elevation myocardial infarction (NSTEMI) complicated by accelerated atherosclerosis potentially associated with ICI therapy in a middle-aged woman with advanced cervical squamous cell carcinoma harboring proficient mismatch repair (pMMR) status. Following successful coronary revascularization, the patient safely reinitiated immunotherapy and achieved long-term sustained tumor-free survival. Case presentation A 39-year-old woman was diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical squamous cell carcinoma, with comorbid type 2 diabetes mellitus and hypertension. She received first-line quadruple combination therapy comprising nab-paclitaxel, cisplatin, bevacizumab, and tislelizumab. Complete tumor response was achieved following six cycles of systemic treatment. Subsequent maintenance therapy combined with pelvic radiotherapy enabled sustained disease remission for more than 5 years. Approximately 2 years after transitioning to single-agent tislelizumab maintenance, the patient experienced an acute NSTEMI. Coronary angiography demonstrated severe multivessel coronary stenosis, and percutaneous coronary intervention (PCI) was performed successfully. After thorough multidisciplinary cardio-oncology evaluation, tislelizumab was safely reinitiated and continued until August 2024. At the most recent follow-up in June 2026, the patient maintained a persistent complete response with stable cardiac function. Conclusion This case highlights that patients with advanced pMMR cervical cancer complicated by diabetes and hypertension can achieve durable complete remission exceeding 5 years with tislelizumab-based combination regimens. Furthermore, this case report also suggests that ICIs may be associated with cardiovascular events secondary to accelerated atherosclerosis, and demonstrates the clinical feasibility of safely resuming immune-checkpoint-inhibitor therapy following myocardial infarction.