Would the Addition of Immunotherapy Impact the Prognosis of Patients With Malignant Pericardial Effusion?

Abstract

Pericardial effusion is a common finding in advanced-stage lung cancer. The presence of malignant cells or drainage of exudate effusion in the pericardial space may cause symptoms of dyspnea, pleuritic chest pain, and syncope. In addition to the difficulty physicians face in the detection and diagnosis of malignant pericardial effusion, treatment may be challenging considering the cancer prognosis and cardiovascular stability of the patient. Despite the availability of several treatment modalities for malignant pericardial effusion, including chemotherapy and surgery, patients with lung cancer historically present with poor prognoses. In addition to lung adenocarcinoma with malignant pericardial effusion, this case was complicated by COVID-19 and malignancy-associated obstructive pneumonia. We present a case of a 64-year-old woman with advanced non-small cell lung carcinoma (NSCLC) with malignant pericardial effusion who, despite testing positive for COVID-19 and having obstructive pneumonia, had favorable outcomes following systemic therapy with combined chemo-immunotherapy.

Malignant Pericardial Effusion Presenting as a Sequela of Lung Adenocarcinoma

“…Non-specific findings for pericardial effusions include cardiomegaly on chest radiography and electrical alterations or low-amplitude findings on electrocardiography [ 4 ]. However, echocardiography remains the gold standard for identifying the size, location, and pathophysiologic impact on the heart [ 4 , 12 ]. The treatment pathway depends on the size of the effusion and a patient's clinical presentation.…”

“…Although pericardial windows are associated with a lower risk of recurrence, in patients with malignant pericardial effusions secondary to lung carcinoma pericardial windows are associated with a lower overall survival outcome. Previous studies have shown that systemic chemotherapy used independently and in combination with pericardial window or pericardiocentesis are effective [ 12 ]. While balloon pericardiotomy or surgical pericardiectomy are also available options, patients with malignant pericardial effusions tend to undergo pericardial window to prevent re-accumulation [ 5 ].…”