1
|
Sung WT, Sakai K, Etou H, Yamamichi R, Yoneda T, Matsuura T, Maruyama T, Nishi D. Cardiac tamponade during pembrolizumab treatment in a patient with ovarian cancer: a case report. Int Cancer Conf J 2023; 12:305-310. [PMID: 37577348 PMCID: PMC10421831 DOI: 10.1007/s13691-023-00621-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023] Open
Abstract
We present the case of a 39-year-old woman with platinum-resistant ovarian cancer who was treated with pembrolizumab. After five cycles of pembrolizumab treatment, she suddenly developed cardiac tamponade with a pleural effusion. The malignant pericardial and pleural effusion had increased, while the other malignant lesions had diminished in size. After pericardial and pleural drainage, no re-accumulation occurred. Pembrolizumab was continued and the patient did not have tumor progression for > 20 months. In some patients with pembrolizumab-induced cardiac tamponade, continuation of pembrolizumab treatment may be possible if other lesions decrease in size and the pericardial effusion can be controlled after drainage.
Collapse
Affiliation(s)
- Wei-Ting Sung
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kunihiro Sakai
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
| | - Haruka Etou
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
| | - Rikiko Yamamichi
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
| | - Tomoko Yoneda
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
| | - Toshiaki Matsuura
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
| | - Tomoyoshi Maruyama
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
| | - Daisuke Nishi
- Department of Obstetrics and Gynecology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001 Japan
| |
Collapse
|
2
|
Suarez ZK, Finke AC, Hospedales E, Perez E, Sharifzadeh A, Foster J, Ferris A. An unusual case of checkpoint-inhibitor-induced pleuropericarditis. J Oncol Pharm Pract 2023; 29:1525-1528. [PMID: 37254508 DOI: 10.1177/10781552231179369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Pembrolizumab is an immune checkpoint inhibitor that promotes effector T-cell functions on malignant cells by binding to programmed cell death protein 1 (PD-1). Pembrolizumab is well tolerated in most cases with an adverse event profile consisting mainly of pruritus, fatigue, and anorexia. Cardiotoxicity comprises 1% of the total adverse events. CASE REPORT We present a case of a 64-year-old female with non-small cell lung cancer (NSCLC) who developed pleuropericarditis following pembrolizumab therapy. MANAGEMENT & OUTCOME The patient was successfully managed with colchicine, furosemide, and timely initiation of methylprednisolone with the improvement of her symptoms. The decision to discontinue pembrolizumab was made, and six months after this intervention, the patient has remained asymptomatic. DISCUSSION Clinicians should recognize these potential immune-mediated adverse effects to provide effective and timely management and optimize patient care.
Collapse
Affiliation(s)
- Zoilo K Suarez
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Ana C Finke
- Internal Medicine Department, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Emilio Hospedales
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Ernesto Perez
- Internal Medicine Department, Kendall Regional Medical Center, Kendall, FL, USA
| | - Arya Sharifzadeh
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Jennifer Foster
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Allison Ferris
- Internal Medicine Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| |
Collapse
|
3
|
Uczkowski D, Ashraf H, Sekhri A, Samad A. Pembrolizumab induced pericardial tamponade: A case report. Clin Case Rep 2023; 11:e7298. [PMID: 37143451 PMCID: PMC10152068 DOI: 10.1002/ccr3.7298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/06/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
Key Clinical Message The occurrence of a large pericardial effusion is not a commonly noted adverse event associated with pembrolizumab and our report demonstrates that a rapid development can be diagnosed with close monitoring and triage to acute medical settings. Abstract Pembrolizumab is an immune checkpoint inhibitor used in various types of cancers. Pericardial tamponade is a rare side effect reported in only very few case reports. Early recognition and therapeutic intervention is vital in all cases. We report a case of a 54-year-old male with Stage 3 lung adenocarcinoma who developed cardiac tamponade secondary to pembrolizumab and subsequently required pericardial window.
Collapse
Affiliation(s)
- Dariusz Uczkowski
- Overlook Medical Center Atlantic Health SystemSummitNew JerseyUSA
- Morristown Medical Center Atlantic Health SystemMorristownNew JerseyUSA
| | - Hamza Ashraf
- Overlook Medical Center Atlantic Health SystemSummitNew JerseyUSA
- Morristown Medical Center Atlantic Health SystemMorristownNew JerseyUSA
| | - Arunabh Sekhri
- Overlook Medical Center Atlantic Health SystemSummitNew JerseyUSA
- Morristown Medical Center Atlantic Health SystemMorristownNew JerseyUSA
| | - Arbaz Samad
- Overlook Medical Center Atlantic Health SystemSummitNew JerseyUSA
- Morristown Medical Center Atlantic Health SystemMorristownNew JerseyUSA
| |
Collapse
|
4
|
Pollock J, Castillo E. Diagnosis and Management of Pembrolizumab-Associated Pericardial Effusion in a Non-small Cell Lung Cancer Patient. Cureus 2023; 15:e37556. [PMID: 37193471 PMCID: PMC10183094 DOI: 10.7759/cureus.37556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
The advent of immune checkpoint inhibitors (ICIs) in the field of oncology has improved the outcome response rate for a variety of neoplastic pathologies with improved cellular specificity that lacks the traditional adverse effects associated with chemotherapy. However, ICIs are not without adverse associations, and a growing concern for modern clinicians is the balancing of interests that most occur to minimize these adverse effects while also improving patients' conditions from an oncologic perspective. This case presents a 69-year-old man who developed multiple episodes of significant pericardial effusion while receiving infusions of pembrolizumab for stage III-A adenocarcinoma for which he underwent a pericardiostomy procedure. Given the positive response of this immunotherapy on disease progression, the decision was made to continue the administration of pembrolizumab following the pericardiostomy with the plan of using serial echocardiography studies to monitor for the presence of clinically significant pericardial effusion in the future. In this way, the patient will still be able to receive optimal treatment for his advanced cancer while preserving adequate cardiac function.
Collapse
Affiliation(s)
- James Pollock
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Elquis Castillo
- Hematology and Oncology, Hematology and Oncology Associates of Alabama, Gadsden, USA
| |
Collapse
|
5
|
Chye AM, Nordman IIC, Sverdlov AL. Successful immune checkpoint inhibitor rechallenge after immune-related pericarditis: Clinical case series. Front Cardiovasc Med 2022; 9:964324. [PMID: 36017099 PMCID: PMC9395697 DOI: 10.3389/fcvm.2022.964324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/22/2022] [Indexed: 12/26/2022] Open
Abstract
Pericardial diseases secondary to immune checkpoint inhibitors (ICI) are rare. Here, we describe two cases of immune-related pericarditis caused by ICI for treatment of advanced NSCLC. Select patients can be successfully rechallenged with ICI after immune-related pericardial disease.
Collapse
Affiliation(s)
- Adrian M. Chye
- Calvary Mater Newcastle, Newcastle, NSW, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
- St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Ina I. C. Nordman
- Calvary Mater Newcastle, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Aaron L. Sverdlov
- Calvary Mater Newcastle, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Cardiovascular Department, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
- Newcastle Centre of Excellence in Cardio-Oncology, New Lambton Heights, NSW, Australia
- *Correspondence: Aaron L. Sverdlov
| |
Collapse
|
6
|
Malik B, Yousaf A, Berrou M, Kunadi A. The Mediport Paradox: Mediastinitis and Pericardial Effusion With a Misplaced Mediport. Cureus 2022; 14:e24562. [PMID: 35497077 PMCID: PMC9049557 DOI: 10.7759/cureus.24562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Totally implantable subcutaneous devices (TISDs) have become excellent options for patients requiring long-term chemotherapy, parenteral nutrition, and fluid replacement. As with all invasive devices and procedures, they come with their inherent risks, which may manifest immediately or at a later point in time. We present the case of a 74-year-old female with a history of hypertension, chronic obstructive pulmonary disease (COPD), ischemic stroke, breast cancer, and lung cancer who had mediport placement for chemotherapy administration. She received several infusions of pembrolizumab through her mediport and developed progressive dyspnea over four weeks. Upon evaluation at our institution, she was found to have a misplaced mediport with mediastinitis and pericardial effusion due to direct mediastinal exposure to immunotherapy. This case highlights the importance of systematic imaging review, regardless of suspected pathology, and encourages providers to have a low threshold to re-evaluate patients after device placement or immunotherapy commencement.
Collapse
|
7
|
Fernández Madrigal L, Montero Pérez O, Rodriguez Garcés MY, Inoriza Rueda Á, Martínez Marcos FJ. Pericardial effusion with pembrolizumab. J Oncol Pharm Pract 2022; 28:1664-1670. [PMID: 35133214 DOI: 10.1177/10781552221077974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The treatment of non-small cell lung cancer (NSCLC) has profoundly changed on account of the arrival of new therapies, like immunotherapy. Within this group of drugs, those aimed at the programmed cell death-1 or programmed cell death ligand-1(PD1/PDL-1) are very relevant, for example, Pembrolizumab. Although its adverse reactions are generally mild and well tolerated, it has been associated with certain immune-related adverse events (IrAEs) than can be serious and affect any organ. CASE REPORT A 62-year-old woman diagnosed with stage IV NSCLC with a single bone metastasis and PD-L1 expression of 60% started treatment with cisplatin-pemetrexed-pembrolizumab, and maintenance with pembrolizumab. MANAGEMENT AND OUTCOME The patient attended the ER with pericardial effusion that was assumed to be a Pembrolizumab IrAE and was managed with corticosteroids. The patient fully recovered but immunotherapy was not reintroduced due to the severity of the AE. DISCUSSION The cardiovascular system is among the least affected organs by immunotoxicity, with an incidence between 0.09-0.6%. However, some authors suspect the incidence is underestimated. Median time to onset is highly variable, ranging from 6 weeks since the first dose to 2 years after discontinuation of the treatment. There are not guidelines on the most effective management of the IrAEs, but according to the pharmaceutical reference, corticosteroids should be initiated followed by a progressive reduction. If no response is obtained, another immunosuppressive agent should be added. The determination to restart immunotherapy depends on the severity of the adverse reaction, the availability of other alternative treatments, and the cancer response.
Collapse
Affiliation(s)
| | - Olalla Montero Pérez
- Unidad de Gestión Clínica Farmacia Hospitalaria, 16839Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | - Ángel Inoriza Rueda
- Unidad de Gestión Clínica Oncología Médica, 16839Hospital Juan Ramón Jiménez, Huelva, Spain
| | | |
Collapse
|
8
|
Sawada R, Matsui Y, Uchino J, Okura N, Morimoto Y, Iwasaku M, Kaneko Y, Yamada T, Takayama K. Late-onset Pleural and Pericardial Effusion as Immune-related Adverse Events after 94 Cycles of Nivolumab. Intern Med 2021; 60:3585-3588. [PMID: 34092733 PMCID: PMC8666223 DOI: 10.2169/internalmedicine.7219-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ryo Sawada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yohei Matsui
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Naoko Okura
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yoshie Morimoto
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yoshiko Kaneko
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| |
Collapse
|
9
|
Shalata W, Abu-salman A, Steckbeck R, Mathew Jacob B, Massalha I, Yakobson A. Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: A Systematic Review. Cancers (Basel) 2021; 13:5218. [PMID: 34680365 PMCID: PMC8534225 DOI: 10.3390/cancers13205218] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 12/26/2022] Open
Abstract
Immune checkpoint inhibitors are immune stimulatory drugs used to treat many types of cancer. These drugs are antibodies against inhibitory proteins, such as CTLA-4 and PD-1/PD-L1, that are expressed on immune cells. When bound, they allow for increased stimulation of T cells to fight tumor cells. However, immune checkpoint inhibitors have several immune-related adverse effects. Many cases have come to light recently of cardiotoxicity as a result of treatment with these drugs. Cardiotoxicity from immune checkpoint inhibitors is unique due to its rarity and high mortality rate. Patients with this toxicity may present with myocarditis, pericarditis, Takotsubo cardiomyopathy, conduction disorders, and others within just a few weeks of starting immune checkpoint inhibitors. We present here a review of the current research on immune checkpoint inhibitors, their associated cardiotoxicities, the timing of presentation of these conditions, lab tests and histology for each condition, and finally the treatment of patients with cardiotoxicity. We observe a positive skew in the onset of presentation, which is significant for the treating physician.
Collapse
Affiliation(s)
- Walid Shalata
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer Sheva 84105, Israel; (I.M.); (A.Y.)
| | - Amjad Abu-salman
- Cardiology Division, Soroka Medical Center, Beer Sheva 84105, Israel;
| | - Rachel Steckbeck
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (R.S.); (B.M.J.)
| | - Binil Mathew Jacob
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (R.S.); (B.M.J.)
| | - Ismaell Massalha
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer Sheva 84105, Israel; (I.M.); (A.Y.)
| | - Alexander Yakobson
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer Sheva 84105, Israel; (I.M.); (A.Y.)
| |
Collapse
|
10
|
Ma Z, Pei J, Sun X, Liu L, Lu W, Guo Q, Lyu J, Liu Y, Zhang Y, Zhao Z. Pericardial Toxicities Associated With Immune Checkpoint Inhibitors: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System (FAERS) Database. Front Pharmacol 2021; 12:663088. [PMID: 34276364 PMCID: PMC8283181 DOI: 10.3389/fphar.2021.663088] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/18/2021] [Indexed: 01/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Zhuo Ma
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jie Pei
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ximu Sun
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Lihong Liu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenchao Lu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qixiang Guo
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiayou Lyu
- A.I. Phoenix Technology Co., Ltd., Hong Kong, China
| | - Yuwei Liu
- A.I. Phoenix Technology Co., Ltd., Hong Kong, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhixia Zhao
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
11
|
Inno A, Maurea N, Metro G, Carbone A, Russo A, Gori S. Immune checkpoint inhibitors-associated pericardial disease: a systematic review of case reports. Cancer Immunol Immunother 2021; 70:3041-3053. [DOI: 10.1007/s00262-021-02938-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
|
12
|
Shannon VR, Anderson R, Blidner A, Choi J, Cooksley T, Dougan M, Glezerman I, Ginex P, Girotra M, Gupta D, Johnson DB, Suarez-Almazor ME, Rapoport BL. Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events: pulmonary toxicity. Support Care Cancer 2020; 28:6145-6157. [PMID: 32880733 PMCID: PMC7471521 DOI: 10.1007/s00520-020-05708-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa
| | - Ada Blidner
- Laboratory of Immunopathology, Institute of Biology and Experimental Medicine-CONICET, Buenos Aires, Argentina
| | - Jennifer Choi
- Division of Oncodermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tim Cooksley
- Manchester University Foundation Trust, Manchester, UK.,The Christie, University of Manchester, Manchester, UK
| | - Michael Dougan
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ilya Glezerman
- Renal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Monica Girotra
- Endocrine Division, Department of Medicine, Weill Cornell Medical College (MG, AF), New York, NY, USA.,Department of Medicine (DJB), Memorial Sloan-Kettering Cancer Center (MC), New York, NY, USA
| | - Dipti Gupta
- Department of Medicine (DJB), Memorial Sloan-Kettering Cancer Center (MC), New York, NY, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN, USA
| | - Maria E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bernardo L Rapoport
- Department of Immunology, Faculty of Health Sciences, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa. .,The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196, South Africa.
| |
Collapse
|
13
|
Bigeh A, Trutter L, Gulati M. Primary Lung Adenocarcinoma Presenting as Cardiac Tamponade in a Pregnant Woman. JACC Case Rep 2020; 2:112-115. [PMID: 34316976 PMCID: PMC8301689 DOI: 10.1016/j.jaccas.2019.11.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 11/28/2022]
Abstract
Pericardial effusions are common in pregnancy and often remain asymptomatic. We present a case of cardiac tamponade in a young pregnant female unmasking a diagnosis of primary metastatic lung adenocarcinoma. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Allison Bigeh
- Department of Medicine, University of Arizona, Phoenix, Arizona
| | - Lindsey Trutter
- Division of Cardiology, University of Arizona, Phoenix, Arizona
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
| |
Collapse
|
14
|
Khan AM, Munir A, Thalody V, Munshi MK, Mehdi S. Cardiac tamponade in a patient with stage IV lung adenocarcinoma treated with pembrolizumab. Immunotherapy 2019; 11:1533-1540. [DOI: 10.2217/imt-2019-0067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Immunotherapy drugs are associated with a multitude of immune-related adverse events. We describe a case of cardiac tamponade in a patient with stage IV lung adenocarcinoma, with almost 100% expression of PDL-1, treated with pembrolizumab. The patient is a 62-year-old male who developed worsening shortness of breath after five cycles of pembrolizumab. He was diagnosed with large pericardial effusion on computed tomography chest. Echocardiogram confirmed tamponade physiology. He was treated with discontinuation of pembrolizumab and urgent pericardial window followed by high dose prednisone with tapering. The patient responded very well to the treatment. We have comprehensively reviewed cases of pericardial effusion secondary to either immune mediated mechanisms or pseudoprogression.
Collapse
Affiliation(s)
- Abdul Moiz Khan
- Department of Internal Medicine, Albany Medical College, Albany, 12208 NY, USA
| | - Ayesha Munir
- Department of Internal Medicine, Albany Medical College, Albany, 12208 NY, USA
| | - Vimala Thalody
- Department of Hematology & Oncology, Stratton VA Medical Center, Albany, 12208 NY, USA
| | | | - Syed Mehdi
- Department of Hematology & Oncology, Stratton VA Medical Center, Albany, 12208 NY, USA
| |
Collapse
|