Immune-mediated Pericarditis With Pericardial Tamponade During Nivolumab Therapy

Almeida, Daniel Vargas Pivato de; Gomes, Jessica Ribeiro; Haddad, Fábio J.; Buzaid, Antônio C.

doi:10.1097/cji.0000000000000217

Cited by 49 publications

(31 citation statements)

References 19 publications

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“…ICI-associated pericardial disease can present as pericarditis, 9,62 pericardial effusion, 9,63,64 or cardiac tamponade. 62,63,65 Perhaps due to under-recognition as an adverse effect of ICI, pericardial disease has been limited to case reports and has not been subject to a systematic review. Pericarditis can present as chest pain relieved by forward position on exam, new pericardial effusion on echocardiogram, new PR depression and diffuse saddle-shaped ST elevation on ECG, or active pericardial inflammation on cMRI (Figure 7) or cardiac PET/CT.…”

Section: Ici-associated Pericardial Diseasementioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

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Cardiovascular toxicities associated with immune checkpoint inhibitors (ICIs) have been reported in case series but have been underappreciated due to their recent emergence, difficulties in diagnosis and non-specific clinical manifestations. ICIs are antibodies that block negative regulators of the T cell immune response, including cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and PD-1 ligand (PD-L1). While ICIs have introduced a significant mortality benefit in several cancer types, the augmented immune response has led to a range of immune-related toxicities, including cardiovascular toxicity. ICI-associated myocarditis often presents with arrhythmias, may co-exist with myositis and myasthenia gravis, can be severe, and portends a poor prognosis. In addition, pericardial disease, vasculitis, including temporal arteritis, and non-inflammatory heart failure, have been recently described as immune-related toxicities from ICI. This narrative review describes the epidemiology, diagnosis, pathophysiology, and treatment of cardiovascular toxicities of ICI therapy, highlighting recent developments in the field in the past year. Keywords Cardio-oncology • Immune checkpoint inhibitors • Myocarditis • Vasculitis • Pericarditis • Cardiovascular toxicity This article is part of the Spotlight Issue on Cardio-oncology.

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Section: Ici-associated Pericardial Diseasementioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

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“… 31 , 32 This was likely related to the homology between targeted antigens and cardiomuscular proteins. 32 …”

Section: Pathophysiologymentioning

confidence: 99%

“…Pericardial disease, Takotsubo cardiomyopathy, and conduction abnormalities including complete heart block have also been reported with ICI use, although they occur less frequently as compared to myocarditis ( Table 2 ). 11 , 12 , 33 , 34 , 35 , 36 , 37 …”

Section: Epidemiologymentioning

confidence: 99%

“…Although clinical trials involving anti-MAGE-A human leukocyte antigen (HLA)-A0201-restricted T-cell receptor (TCR) showed clinical regression of cancer, their use has been shown to be associated with neurotoxicity and cardiotoxicity 31, 32. This was likely related to the homology between targeted antigens and cardiomuscular proteins 32 …”

Section: Pathophysiologymentioning

confidence: 99%

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Managing cardiotoxicity associated with immune checkpoint inhibitors

Upadhrasta

Elias

Patel

et al. 2019

Chronic Diseases and Translational Medicine

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Immuno-oncology is a fast evolving field of cancer therapy and immune checkpoint inhibitors (ICIs) are clearly a breakthrough in this field. Cardiotoxicity with conventional anti-cancer therapies has been well studied in the past and clear guidelines for management of these side effects are available in the literature. However, cardiotoxicity with novel agents such as ICIs has been fairly under-reported and/or underestimated and we are yet to formulate clear guidelines for management of these rare side effects. In the last few years, there has been an overall increase in the number of cases of cardiotoxicity related to ICIs. In this literature review, we describe the mechanism of action of the most widely used ICIs and their related cardiotoxicities. The increase in number of case reports about the potential of cardiotoxicities with these novel agents clearly indicates the need for a new insight into the field of cardio-immuno-oncology.

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“…Despite the low frequency, these complications are often serious, with a variety of clinical profiles described [6]. There are reports of fulminant fatal cardiac toxicity, electrical dysfunction, acute coronary syndrome, pericarditis, and acute systolic heart failure occurring after ICI therapy [7][8][9][10][11][12][13]. Defining the frequency and patterns of cardiac toxicity from ICI therapy is an area of active investigation [14].…”

Section: Introductionmentioning

confidence: 99%

Severe combined cardiac and neuromuscular toxicity from immune checkpoint blockade: an institutional case series

Arora¹,

Talamo

Dillon

et al. 2020

Cardio-Oncology

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Background Immune checkpoint inhibition is part of standard systemic management for many advanced malignancies. Toxicities from this treatment approach are unpredictable, though usually reversible with management per established guidelines. Some patients suffer major morbidity and treatment-related mortality from these agents in an unpredictable manner. Cardiac and neurologic complications are rare, but can result in serious clinical consequences. Methods We describe the presentation, management, and outcomes of eight sequential cases of combined cardiac and neurologic toxicities resulting in severe illness and demonstrating lack of rapid response to immunosuppression. Results Our cohort consisted of six males and two females with an average age of 73.5 years (61–89 years). There were four patients with melanoma, and one patient each with urothelial carcinoma, renal cell carcinoma, breast cancer, and non-small cell lung cancer. Four patients received combination immunotherapy and four patients received monotherapy. The median time to presentation from treatment initiation was 27 days (11–132 days). All patients had a cardiovascular and neurologic toxicity, and most had hepatitis and myositis. The cardiac signs and symptoms were the prominent initial features of the clinical presentation. Each patient was managed by a multidisciplinary team and received a range of immunosuppressive agents. All patients died as a consequence of the immune related adverse events. Conclusions The evaluation of patients with cardiac adverse events from immunotherapy, should include assessment of overlapping toxicities such as myasthenia gravis and myositis. Providers should be aware of the potential for an extended duration of disability and slow improvement for certain toxicities as these expectations may factor prominently in goals of care decisions.

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Immune-mediated Pericarditis With Pericardial Tamponade During Nivolumab Therapy

Cited by 49 publications

References 19 publications

Cardiovascular toxicities associated with immune checkpoint inhibitors

Cardiovascular toxicities associated with immune checkpoint inhibitors

Managing cardiotoxicity associated with immune checkpoint inhibitors

Severe combined cardiac and neuromuscular toxicity from immune checkpoint blockade: an institutional case series

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