Pericardial effusion due to pembrolizumab-induced immunotoxicity: A case report and literature review

Atallah‐Yunes, Suheil Albert; Kadado, Anis John; Soe, Myat Han

doi:10.1016/j.currproblcancer.2019.01.001

Cited by 16 publications

(14 citation statements)

References 26 publications

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“…ICI-related pericarditis may occur with or without pericardial effusion and tamponade (Yun et al, 2015;Heinzerling et al, 2016). Perhaps because of inadequate understanding as a form of ICI-related cardiovascular disorders, data on pericardial disease are derived primarily from case reports and clinical trials that may not correctly represent the real world (Borghaei et al, 2015;Kushnir and Wolf, 2017;Atallah et al, 2019;Yamasaki et al, 2019). Moreover, the characteristics, timing, outcomes of ICI-related pericardial toxicities and the factors associated with death are still unknown.…”

Section: Introductionmentioning

confidence: 99%

Pericardial Toxicities Associated With Immune Checkpoint Inhibitors: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System (FAERS) Database

Pei

Sun

et al. 2021

Front. Pharmacol.

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Introdution: Immune checkpoint inhibitors (ICIs) have significantly improved clinical outcomes for a wide range of cancers but can also lead to serious or fatal immune-related adverse events (irAEs). Although ICI-related pericardial toxicities have been reported, the clinical features are not well characterized in real-world studies.Objective: To characterize the main features of ICI-related pericardial toxicities and identify factors associated with death.Methods: Data from January 1, 2011 to March 31, 2020 in the FDA Adverse Event Reporting System database were retrieved for disproportionality analysis. We used the reporting odds ratio and the information component (IC) to evaluate the association between ICIs and pericardial adverse events. Clinical characteristics of patients with ICI-associated pericardial toxicities were collected and compared between fatal and non-fatal groups. The time to onset following different ICI regimens was further investigated.Results: We identified a total of 705 ICI-associated pericardial toxicities which appeared to influence more men (53.90%) than women (36.03%), with a median age of 63 (interquartile range [IQR] 54–69) years. Patients with lung cancer accounted for the largest proportion (55.6%). ICI therapies were detected with pharmacovigilance signals of pericardial toxicities, corresponding to IC025 = 2.11 and ROR 4.87 [4.51–5.25]. Nevertheless, there was a lack of association between anti-CTLA-4 and pericardial toxicities. There was no difference in onset time among all ICI regimens. However, TTO of fatal cases (25 days (interquartile range [IQR] 6–70)) occurred statistically earlier than non-fatal cases (42 days (IQR 12–114), p = 0.003).Conclusion: ICI monotherapy (PD-1/PD-L1 therapy) and combination therapy can lead to pericardial toxicities that can result in serious outcomes and tend to occur early. Early recognition and management of ICI-related pericardial disorders should attract clinical attention. The findings require further clinical surveillance for the quantification.

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Section: Introductionmentioning

confidence: 99%

Pericardial Toxicities Associated With Immune Checkpoint Inhibitors: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System (FAERS) Database

Pei

Sun

et al. 2021

Front. Pharmacol.

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“…Five cases were related to pseudoprogression (1-3). The other 16 cases were considered irAEs (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The latest onset of effusions as described in previous reports was after 35 cycles of ICI (4).…”

Section: Discussionmentioning

confidence: 99%

“…Pericardial effusion has been reported as an immunerelated adverse event (irAE) in patients receiving immune checkpoint inhibitors (ICIs) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, only two cases of pleural effusion in patients on ICIs have been documented, and they were related to pseudoprogression (1).…”

Section: Introductionmentioning

confidence: 99%

Late-onset Pleural and Pericardial Effusion as Immune-related Adverse Events after 94 Cycles of Nivolumab

et al. 2021

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A 67-year-old man with primary lung adenocarcinoma was hospitalized due to massive bilateral pleural effusion and pericardial effusion after 94 cycles of nivolumab therapy. We were unable to identify the cause of these effusions using blood tests, cytology tests, or bacterial culture of pleural effusion and thoracoscopy. Finally, we administrated corticosteroids, which immediately improved the fluid accumulation. This case may support the introduction of corticosteroids for late-onset pleural and pericardial effusion during immune checkpoint inhibitor (ICI) treatment. However, the safety of rechallenge of ICIs after the improvement of fluid accumulation is controversial.

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“…Patients using immune checkpoint inhibitor chemotherapy agents primarily develop side effects related to excessive immune activation with varying levels of cardiotoxicity ( 6 ). Several cases of pericardial effusions and tamponade have been reported in pembrolizumab specifically (a PDL-1 inhibitor) ( 4 , 7 , 8 ). This case was also complicated by the development of effusive-constrictive pericarditis that began after she was initiated on chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Primary Lung Adenocarcinoma Presenting as Cardiac Tamponade in a Pregnant Woman

2020

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Pericardial effusion due to pembrolizumab-induced immunotoxicity: A case report and literature review

Cited by 16 publications

References 26 publications

Pericardial Toxicities Associated With Immune Checkpoint Inhibitors: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System (FAERS) Database

Pericardial Toxicities Associated With Immune Checkpoint Inhibitors: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System (FAERS) Database

Late-onset Pleural and Pericardial Effusion as Immune-related Adverse Events after 94 Cycles of Nivolumab

Primary Lung Adenocarcinoma Presenting as Cardiac Tamponade in a Pregnant Woman

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