Recurrent Pericardial Effusion While Receiving Nivolumab for Metastatic Lung Adenocarcinoma: Case Report and Review of the Literature

Vittorio, Alexander F; Sharma, Rajiv; Siejka, Dylan A; Bhattarai, Keshav; Hardikar, Ashutosh

doi:10.1016/j.cllc.2018.05.010

Cited by 17 publications

(11 citation statements)

References 16 publications

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“…Table lists the publications on pericardial effusion or pericardial tamponade following anti‐PD‐1 immunotherapy in lung cancer patients . Increasing pericardial effusion is often observed within three months of the start of anti‐PD‐1 immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…reported that pericardial effusion was effectively managed using corticosteroids, implying that their patients had irAEs. Other studies have indicated that some pericardial effusions in lung cancer patients with tamponade may be caused by pseudoprogression …”

Section: Discussionmentioning

confidence: 99%

“…Several studies show temporary and sudden increases in pericardial effusion during anti‐PD‐1 immunotherapy probably due to pseudoprogression or irAEs, but the mechanisms remain unclear. Whether an anti‐PD‐1 immunotherapy should be continued after pericardial effusion progression remains a controversial issue.…”

Section: Introductionmentioning

confidence: 99%

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

Harada

Ogasawara²,

Shido

et al. 2020

Thoracic Cancer

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Harada

Ogasawara²,

Shido

et al. 2020

Thoracic Cancer

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“…Some studies reported on pericardial effusion after the initiation of nivolumab therapy [8][9][10][11]. All cases in these previous literatures needed pericardiocentesis.…”

Section: Discussionmentioning

confidence: 99%

Management of Cardiac Tamponade During Nivolumab Of Lung Cancer with Intrapericardial Bleomycin: Case Report

et al. 2019

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Immuno-checkpoint inhibitor response and immune-related adverse events remain controversial issues. Managing pericardial effusion during programmed cell death 1 inhibitor treatment is challenging. Here, we report a case of successfully managed cardiac tamponade caused by nivolumab-induced pseudoprogression. A 62-year-old male diagnosed with advanced lung adenocarcinoma started on nivolumab. Seven days later, he experienced cardiac tamponade and required pericardiocentesis, and other lesions were larger on computed tomography. The patient's condition stabilized after pericardiocentesis. However, although the lesions other than pericardial effusion were reduced on chest CT, cardiac tamponade recurred after 6 weeks. We considered that the case involved cardiac tamponade induced by pseudoprogression and administered intrapericardial bleomycin after pericardiocentesis. Thereafter, the patient was administered nivolumab for 7 months until disease progression.

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“…Rapidly recurrent pleural and pericardial effusions have been reported following anti-PD-1 therapies[10,[71][72][73][74][75]. These effusions typically develop early, within 6-8 weeks of initiation of therapy.…”

mentioning

confidence: 99%

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events: pulmonary toxicity

Shannon

Anderson

Blidner

et al. 2020

Support Care Cancer

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The immune checkpoints associated with the CTLA-4 and PD-1 pathways are critical modulators of immune activation. These pathways dampen the immune response by providing brakes on activated T cells, thereby ensuring more uniform and controlled immune reactions and avoiding immune hyper-responsiveness and autoimmunity. Cancer cells often exploit these regulatory controls through a variety of immune subversion mechanisms, which facilitate immune escape and tumor survival. Immune checkpoint inhibitors (ICI) effectively block negative regulatory signals, thereby augmenting immune attack and tumor killing. This process is a double-edged sword in which release of regulatory controls is felt to be responsible for both the therapeutic efficacy of ICI therapy and the driver of immune-related adverse events (IrAEs). These adverse immune reactions are common, typically low-grade and may affect virtually every organ system. In the early clinical trials, lung IrAEs were rarely described. However, with ever-expanding clinical applications and more complex ICI-containing regimens, lung events, in particular, pneumonitis, have become increasingly recognized. ICI-related lung injury is clinically distinct from other types of lung toxicity and may lead to death in advanced stage disease. Thus, knowledge regarding the key characteristics and optimal treatment of lung-IrAEs is critical to good outcomes. This review provides an overview of lung-IrAEs, including risk factors and epidemiology, as well as clinical, radiologic, and histopathologic features of ICI-related lung injury. Management principles for ICI-related lung injury, including current consensus on steroid refractory pneumonitis and the use of other immune modulating agents in this setting are also highlighted.

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Recurrent Pericardial Effusion While Receiving Nivolumab for Metastatic Lung Adenocarcinoma: Case Report and Review of the Literature

Cited by 17 publications

References 16 publications

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

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

Management of Cardiac Tamponade During Nivolumab Of Lung Cancer with Intrapericardial Bleomycin: Case Report

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events: pulmonary toxicity

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