Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Am J Cardiol. 2019 Apr 15;123(8):1351-1357. doi: 10.1016/j.amjcard.2019.01.013. Epub 2019 Jan 25.
Case reports have reported immune checkpoint inhibitors (ICI), especially nivolumab, are associated with recurrent pericardial effusions. Our objective was to determine how often patients being treated with ICI develop hemodynamically significant pericardial effusion requiring pericardiocentesis compared with other cancer therapeutics and whether the survival of patients who underwent pericardiocentesis differs according to ICI use versus standard cancer therapeutics. Our institutional review board approved catheterization laboratory data collection for all pericardiocenteses performed and all patients receiving ICI from January 1, 2015 to December 31, 2017. Retrospective review of the electronic medical record was performed to identify cancer therapeutics given preceding pericardiocentesis. Log-rank analysis was performed to compare survival in patients requiring pericardiocentesis between those on ICI and those not on ICI. Overall, 3,966 patients received ICI of which only 15 pericardiocenteses were required, including 1 repeat pericardiocentesis in a patient on nivolumab. The prevalence of pericardiocentesis among patients on ICI was 0.38% (15/3,966). Eleven pericardiocenteses were performed after nivolumab infusion, 3 after pembrolizumab, and 1 after atezolizumab, with pericardiocentesis prevalences for each agent of 0.61% (11/1,798), 0.19% (3/1,560), and 0.32% (1/309), respectively. One hundred and twenty pericardiocentesis were performed on patients receiving other cancer therapeutics although no therapeutic agent was associated with more pericardiocenteses than nivolumab. In conclusion, the prevalence of hemodynamically significant pericardial effusions and ICI administration is uncommon, and survival durations after pericardiocentesis for patients receiving ICI and those not receiving ICI are similar, suggesting that frequent echocardiographic monitoring for pericardial effusions is not necessary.
病例报告显示，免疫检查点抑制剂（ICI），特别是纳武单抗，与复发性心包积液有关。我们的目的是确定与其他癌症治疗药物相比，接受 ICI 治疗的患者发生需要进行心包穿刺的心包积液的频率，以及接受心包穿刺的患者的生存是否因使用 ICI 与标准癌症治疗药物而有所不同。我们的机构审查委员会批准了对 2015 年 1 月 1 日至 2017 年 12 月 31 日期间所有进行的心包穿刺术和所有接受 ICI 的患者的导管实验室数据进行采集。对电子病历进行回顾性审查，以确定心包穿刺术前使用的癌症治疗药物。对数秩分析用于比较接受心包穿刺术的患者在 ICI 组和非 ICI 组之间的生存情况。总体而言，有 3966 例患者接受了 ICI，其中仅需要进行 15 次心包穿刺术，包括 1 例接受纳武单抗治疗的患者重复心包穿刺术。接受 ICI 的患者中，心包穿刺术的患病率为 0.38%（15/3966）。11 次心包穿刺术是在纳武单抗输注后进行的，3 次在 pembrolizumab 后进行，1 次在 atezolizumab 后进行，每种药物的心包穿刺术患病率分别为 0.61%（11/1798）、0.19%（3/1560）和 0.32%（1/309）。在接受其他癌症治疗药物的患者中进行了 120 次心包穿刺术，但没有任何治疗药物与纳武单抗相比，心包穿刺术的次数更多。总之，有症状的心包积液和 ICI 给药的发生率并不常见，接受 ICI 和未接受 ICI 的患者在心包穿刺术后的生存时间相似，这表明不需要频繁进行超声心动图监测心包积液。
