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Immune checkpoint inhibitors and pericardial disease: a systematic review.
Mudra, Sarah E; Rayes, Danny L; Agrawal, Ankit; Kumar, Ashwin K; Li, Jason Z; Njus, Meredith; McGowan, Kevin; Kalam, Kazi A; Charalampous, Charalompos; Schleicher, Mary; Majid, Muhammad; Syed, Alvena; Yesilyaprak, Abdullah; Klein, Allan L.
Affiliation
  • Mudra SE; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • Rayes DL; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • Agrawal A; Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
  • Kumar AK; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • Li JZ; Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
  • Njus M; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • McGowan K; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • Kalam KA; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • Charalampous C; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • Schleicher M; Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
  • Majid M; Floyd D. Loop Memorial Library, Cleveland Clinic, Cleveland, OH, USA.
  • Syed A; Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
  • Yesilyaprak A; Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
  • Klein AL; Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
Cardiooncology ; 10(1): 29, 2024 May 17.
Article in En | MEDLINE | ID: mdl-38760863
ABSTRACT

INTRODUCTION:

Despite the growing use of immune checkpoint inhibitors (ICI) in cancer treatment, data regarding ICI-associated pericardial disease are primarily derived from case reports and case series. ICI related pericardial disease can be difficult to diagnose and is associated with significant morbidity. We conducted a systematic review to further characterize the epidemiology, clinical presentation, and outcomes of this patient population.

METHODS:

A search of four databases resulted in 31 studies meeting inclusion criteria. Patients > 18 years old who presented with ICI mediated pericardial disease were included. Intervention was medical + surgical therapy and outcomes were development of cardiac tamponade, morbidity, and mortality.

RESULTS:

Thirty- eight patients across 31 cases were included. Patients were majority male (72%) with a median age of 63. Common symptoms included dyspnea (59%) and chest pain (32%), with 41% presenting with cardiac tamponade. Lung cancer (81%) was the most prevalent, and nivolumab (61%) and pembrolizumab (34%) were the most used ICIs. Pericardiocentesis was performed in 68% of patients, and 92% experienced symptom improvement upon ICI cessation. Overall mortality was 16%.

DISCUSSION:

This study provides the most comprehensive analysis of ICI-mediated pericardial disease to date. Patients affected were most commonly male with lung cancer treated with either Nivolumab or Pembrolizumab. Diagnosis may be challenging in the setting of occult presentation with normal EKG and physical exam as well as delayed onset from therapy initiation. ICI-associated pericardial disease demonstrates high morbidity and mortality, as evidenced by a majority of patients requiring pericardiocentesis.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Cardiooncology Year: 2024 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Cardiooncology Year: 2024 Document type: Article Affiliation country: Country of publication: