Pericardial tamponade during pembrolizumab treatment in a patient with advanced lung adenocarcinoma: A case report and review of the literature

Abstract

Several studies have demonstrated increased pericardial effusion during anti-PD-1 immunotherapy, and treatment in patients who have developed pericardial tamponade is controversial. In this study, we describe a 63-year-old woman with stage IVA lung adenocarcinoma given pembrolizumab as a first-line therapy. After four cycles of pembrolizumab treatment, the patient suddenly developed a pericardial tamponade. Although pericardial effusion was increased, her tumor lesions were reduced. After an emergency pericardiocentesis, she continued the pembrolizumab therapy without recurrent pericardial effusions for three months until the primary tumor and lymph node metastasis progressed. Nine months after the pericardiocentesis, the patient died of progressive lung cancer, but pericardial effusion did not recur throughout the treatment course. This case study suggests that pembrolizumab therapy can be continued with a strict follow-up in some patients with pembrolizumab-induced pericardial tamponade. Key points• Significant findings of the study Our patient developed pericardial tamponade during pembrolizumab treatment but continued pembrolizumab treatment after emergency pericardiocentesis without recurrent pericardial effusions.• What this study adds Pembrolizumab treatments may be resumed with a strict follow-up in some patients with treatment-related pericardial tamponade. Figure 1 (a) A computed tomography (CT) scan of the chest showed a mass lesion in the right upper lobe. A right supraclavicular lymph node metastasis infiltrated into the right thyroid lobe before pembrolizumab treatment. Mild pericardial effusion was observed. (b) After three cycles of pembrolizumab therapy, CT scan showed a positive response in the primary lesion and lymph node metastasis. (c) A CT revealed a sudden increase in pericardial effusion and the tumor lesions were reduced after four cycles of pembrolizumab therapy.

Pericardial effusion with pembrolizumab

“…Several cases of pericardial effusion have been reported by Pembrolizumab in other non-lung cancers. 23 –32…”

“…As shown in Table 1, these publications reported a total of 21 cases [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] (7 women; 14 men) of patients with an age range between 46 and 79 years and with a median of 65 years. The most frequent histology was lung adenocarcinoma (n = 15), followed by squamous cell carcinoma of the lung (n = 3).…”

Checkpoint-inhibitor induced Polyserositis with Edema

“…While pericardial effusions in patients with advanced lung cancer after treatment with nivolumab have been reported [ 10 , 18 , 20 ] and might be life-threatening due to pericardial tamponade [ 12 ], no reports on irPolyserositis exist to our knowledge. The onset of irSerositis is often acute with respiratory failure and chest pain [ 13 – 16 ], but can also be slowly progressive with weight gain or progressive exertional dyspnea (Case 1–4 [ 7 ]).…”

A Rare Cause of Dyspnea in SARS-CoV-2 Emergency: A Case of Cardiac Tamponade During Pembrolizumab Immunotherapy for Lung Cancer

“…A case of cardiac tamponade during pembrolizumab for advanced lung adenocarcinoma has been previously reported [7].…”

“…However, pericardial effusion developed slowly and after a relatively long treatment period (i.e., four cycles). Therefore, pembrolizumab was safely continued after successful pericardiocentesis [7].…”