TITLE:
Pericardial Effusion with Tamponade, an Immune-Related Adverse Event Associated with Nivolumab Therapy: A Case Report and Review of the Literature
AUTHORS:
Fauzia F. Naime
KEYWORDS:
Pericardial Effusion, Immunotherapy, Nivolumab, Non-Small Cell Lung Cancer (NSCLC), Immune Related Adverse Events
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.9 No.12,
December
29,
2018
ABSTRACT: Immune
checkpoint inhibitors have shown to be very effective when treating lung
cancer. Nivolumab, a programmed death-1 (PD-1) inhibitor has
been approved for the treatment of metastatic non-squamous and squamous NSCLC.
Immunotherapy with checkpoint inhibitors are associated with toxicities defined
as immune-related
adverse events (irAEs). The most common
irAEs are rash, colitis, hepatitis, pneumonitis, and endocrinopathies. Although
any organ system can be affected, other rare irAEs can occur and affect the
bone marrow, pancreas, and the neurologic and cardiac systems. Pericardial
effusion induced by immunotherapy is uncommon and has been described only in a
few case reports. Immune-related adverse events usually develop within the
first weeks to months after treatment initiation. This is a case report of a 52-year-old
male patient with metastatic squamous-cell lung cancer who had a massive
pericardial effusion secondary to treatment with nivolumab as second line treatment.
During his hospital stay, the patient underwent pericardiocentesis and
treatment with corticosteroids. A CT scan after these treatments revealed
complete tumor response and minimal pericardial effusion. Nivolumab was definitively ceased. The patient continues to show complete response for 16 months. In general,
Nivolumab is well-tolerated and has an excellent safety profile.
However, it is important to be aware of life-threatening immune-related adverse
events, particularly cardiac toxicity. Consensus guidelines regarding the
treatment of the most common irAEs have been established. The optimal
management of irAEs is based on clinical experience. It’s crucial to report new
or rare irAEs to conduct prospective trials to evaluate the best treatment
strategy.