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

Asai, Maiko; Kato, Yasuhiro; Kawai, Shoko; Watanabe, Kageaki; Yomota, Makiko; Okuma, Yusuke; Hosomi, Yukio; Hishima, Tsunekazu; Okamura, Tatsuru

doi:10.2217/imt-2019-0003

Cited by 21 publications

(19 citation statements)

References 18 publications

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“…Despite the low incidence of pericardial effusion under nivolumab in these studies, 13 cases have been reported in the literature since 2016 [12–21]. We report on 3 new cases of early and late-onset pericardial effusion in patients with NSCLC treated with nivolumab.…”

Section: Discussionmentioning

confidence: 91%

Pericardial effusion under nivolumab: case-reports and review of the literature

Saade

Lupo

Arrondeau

et al. 2019

j. immunotherapy cancer

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BackgroundNivolumab, a programmed death-1 (PD-1) inhibitor, is an immune checkpoint inhibitor particularly used in the treatment of malignant melanoma, non-small cell lung cancer and renal cell carcinoma. Immune-related adverse events are frequent under immunotherapies. Cardiotoxic side effects, initially thought to be rare, are more often encountered paralleling the expanding use of immune checkpoint blockade. Among them, pericardial effusion and tamponade deserve attention as they may present with unusual symptomatology.Case presentationWe report three cases of pericardial effusion under nivolumab for lung adenocarcinoma. Two cases of early and late-onset pericardial effusion were symptomatic with tamponade and one case occurred without any symptoms. Pericardiocentesis with pericardial biopsy was performed in symptomatic pericardial effusion followed by the administration of a corticotherapy. Pericardial biopsies showed infiltration of T-lymphocytes, mostly CD4+. Nivolumab was stopped in two cases and resumed for one patient. Pericardial effusion evolved positively in all cases with or without treatment.ConclusionsWe review the literature on pericardial effusion under nivolumab to further discuss the hallmarks of pericardial effusion under nivolumab and the management of nivolumab therapy in this situation. In conclusion, pericardial effusion as an immune-related adverse event under nivolumab appears less rare than initially thought and may require particular attention.

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Section: Discussionmentioning

confidence: 91%

Pericardial effusion under nivolumab: case-reports and review of the literature

Saade

Lupo

Arrondeau

et al. 2019

j. immunotherapy cancer

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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%

“…Monitoring pericardial effusions and other lesions is important to determine whether the cause of the effusion is pseudoprogression or not. Based on the evidence, anti‐PD‐1 immunotherapy may be resumed under close observation if the antitumor effect at other sites is notable and the pericardial fluid is controllable …”

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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Tumor Hyperprogression and Pseudoprogression After Immunotherapy

Farhat

Rezaei

2023

Handbook of Cancer and Immunology

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

Cited by 21 publications

References 18 publications

Pericardial effusion under nivolumab: case-reports and review of the literature

Pericardial effusion under nivolumab: case-reports 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

Tumor Hyperprogression and Pseudoprogression After Immunotherapy

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