Nivolumab,程序性死亡-1(PD-1)抑制剂,是一种免疫检查点抑制剂,特别用于治疗恶性黑色素瘤,非小细胞肺癌和肾细胞癌。在免疫疗法下,免疫相关的不良事件很常见。心脏毒性副作用,最初被认为是罕见的,与免疫检查点阻断的扩大使用并行更经常遇到。其中,心包积液和填塞值得关注,因为它们可能表现出异常的症状。
我们报告了3例nivolumab治疗肺腺癌的心包积液。2例早期和迟发性心包积液有症状并填塞,1例没有任何症状。在有症状的心包积液中进行心包穿刺术和心包活检,然后进行皮质治疗。心包活检显示T淋巴细胞浸润,主要是CD4+。在2例患者中停止了Nivolumab,并在1例患者中恢复了Nivolumab。在有或没有治疗的所有病例中,心包积液均呈积极发展。
我们回顾了关于nivolumab下心包积液的文献,以进一步讨论nivolumab下心包积液的标志以及在这种情况下nivolumab治疗的管理。总之,在nivolumab治疗下,心包积液作为免疫相关的不良事件似乎没有最初认为的那么罕见,可能需要特别注意.
Nivolumab, a programmed death-1 (PD-1) inhibitor, is an immune checkpoint inhibitor particularly used in the treatment of malignant melanoma, non-small cell lung cancer and renal cell carcinoma. Immune-related adverse events are frequent under immunotherapies. Cardiotoxic side effects, initially thought to be rare, are more often encountered paralleling the expanding use of immune checkpoint blockade. Among them, pericardial effusion and tamponade deserve attention as they may present with unusual symptomatology.
We report three cases of pericardial effusion under nivolumab for lung adenocarcinoma. Two cases of early and late-onset pericardial effusion were symptomatic with tamponade and one case occurred without any symptoms. Pericardiocentesis with pericardial biopsy was performed in symptomatic pericardial effusion followed by the administration of a
corticotherapy. Pericardial biopsies showed infiltration of T-lymphocytes, mostly CD4+. Nivolumab was stopped in two cases and resumed for one patient. Pericardial effusion evolved positively in all cases with or without treatment.
We
review the literature on pericardial effusion under nivolumab to further discuss the hallmarks of pericardial effusion under nivolumab and the management of nivolumab therapy in this situation. In conclusion, pericardial effusion as an immune-related adverse event under nivolumab appears less rare than initially thought and may require particular attention.