Cardiology Division, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore (LU), Italy.
Medical Oncology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore (LU), Italy.
Adv Ther. 2020 Jul;37(7):3178-3184. doi: 10.1007/s12325-020-01386-y. Epub 2020 May 20.
Cardiovascular toxicity of immunotherapy represents an underreported but potentially fatal side effect. A relatively high incidence of pericardial disease has been noticed in patients with non-small cell lung cancer (NSCLC).
We retrospectively analyzed a population of patients with advanced NSCLC receiving immune checkpoint inhibitors (ICIs) looking for the presence of pericardial effusion at baseline or during treatment. The study population was compared with a control group treated with chemotherapy. All patients were checked for the presence of concomitant pleural effusion.
We identify 60 patients (36 male/24 female, median age 70 years [range 43-81]). Prevalent histology was adenocarcinoma (65%) followed by squamous cell carcinoma (28%) and large cell or not otherwise specified (NOS) carcinoma (7%). Treatment consisted of nivolumab 3 mg/kg every 14 days (52 cases; 45 as second-line and 7 as third-line treatment) or pembrolizumab 200 mg (8 cases; all first-line treatment) for a total of 302 cycles delivered. Four out of 60 patients (6.7%) developed pericardial effusion during treatment, in two cases (3.3%) without concomitant pleural effusion, compared to 2 out of 60 (3.3%) in the control group in one case without concomitant pleural effusion (1.6%). Median time of onset was 40 days. Myocarditis was not observed.
Our findings confirm pericardial effusion as a relatively frequent side effect of immunotherapy in NSCLC. Clinicians should be aware of this specific toxicity in patients with metastatic NSCLC receiving immunotherapy and refer to a cardiologist for a multidisciplinary approach.
免疫疗法的心血管毒性是一种报道较少但可能致命的副作用。在非小细胞肺癌（NSCLC）患者中，已注意到心包疾病的发病率相对较高。
我们回顾性分析了接受免疫检查点抑制剂（ICI）治疗的晚期 NSCLC 患者人群，以寻找基线或治疗期间心包积液的存在。将研究人群与接受化疗的对照组进行比较。所有患者均检查是否存在同时性胸腔积液。
我们确定了 60 名患者（36 名男性/24 名女性，中位年龄 70 岁[范围 43-81]）。主要组织学类型为腺癌（65%），其次为鳞状细胞癌（28%）和大细胞或未另作具体说明（NOS）癌（7%）。治疗包括纳武利尤单抗 3 mg/kg 每 14 天（52 例；45 例二线治疗，7 例三线治疗）或帕博利珠单抗 200 mg（8 例；均为一线治疗），共给予 302 个周期。60 名患者中有 4 名（6.7%）在治疗期间发生心包积液，其中 2 名（3.3%）无同时性胸腔积液，而对照组中有 2 名（3.3%）在 1 名患者中出现无同时性胸腔积液（1.6%）。中位发病时间为 40 天。未观察到心肌炎。
我们的发现证实了心包积液是 NSCLC 患者免疫治疗中相对常见的副作用。临床医生应注意转移性 NSCLC 接受免疫治疗的患者的这种特定毒性，并转介给心脏病专家进行多学科治疗。
