Pollock James, Castillo Elquis
Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA.
Hematology and Oncology, Hematology and Oncology Associates of Alabama, Gadsden, USA.
Cureus. 2023 Apr 14;15(4):e37556. doi: 10.7759/cureus.37556. eCollection 2023 Apr.
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.
免疫检查点抑制剂（ICI）在肿瘤学领域的出现提高了多种肿瘤病理类型的疗效反应率，其细胞特异性更强，且没有传统化疗相关的不良反应。然而，ICI并非没有不良关联，现代临床医生日益关注的是如何平衡利益，即在尽量减少这些不良反应的同时，从肿瘤学角度改善患者状况。本病例介绍了一名69岁男性，他在接受帕博利珠单抗输注治疗III - A期腺癌时出现多次大量心包积液，为此接受了心包造口术。鉴于这种免疫疗法对疾病进展有积极反应，决定在心包造口术后继续使用帕博利珠单抗，并计划通过系列超声心动图检查监测未来是否存在具有临床意义的心包积液。通过这种方式，患者仍能够在保留足够心脏功能的同时接受晚期癌症的最佳治疗。
