Recurrent pleural effusions and cardiac tamponade as possible manifestations of pseudoprogression associated with nivolumab therapy- a report of two cases

被引:73
作者
Kolla, Bhaskar C. [1 ]
Patel, Manish R. [1 ]
机构
[1] Univ Minnesota, MMC 480, 420 Delaware St SE, Minneapolis, MN 55455 USA
关键词
Immunotherapy; Nivolumab; Recurrent pleural effusions; Pericardial effusion; Pericardial tamponade; Lung cancer; Immune related adverse effects; IMMUNE-RELATED RESPONSE; DOCETAXEL;
D O I
10.1186/s40425-016-0185-2
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Checkpoint inhibitors are a class of agents that employ host's adaptive immune defenses in fighting cancer. With many new indications and several ongoing clinical trials in a variety of malignancies, the usage of these agents is set to increase significantly. One of the key challenges patients and physicians face while using these drugs is with the appropriate assessment of response to therapy. Case presentation: We are reporting two patients with lung cancer who were treated with nivolumab and experienced rapidly accumulating recurrent pleural effusions requiring multiple thoracenteses (6 and 4 times each for patient 1 and 2 respectively) with in the first few weeks of initiation of therapy and also developed pericardial effusion with cardiac tamponade requiring pericardiocentesis. Both patients had prior history of malignant spread to pleural and pericardial space in their disease course. Therapy was continued in the first patient with spontaneous resolution of effusions after 8 weeks and the disease showed near complete response to treatment on imaging at 16 weeks. Second patient declined to continue further treatment with nivolumab after 3 cycles due to recurrent effusions and cardiac tamponade, although there was some evidence of clinical response at discontinuation. Conclusions: Patients with history of malignant involvement of visceral spaces should be monitored closely for rapidly accumulating effusions and particularly for cardiac tamponade, after initiation of therapy with nivolumab. This presentation could represent pseudoprogression, and continuation of therapy with close monitoring is prudent as long as effusions are manageable and there is no definitive evidence of progression elsewhere.
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相关论文
共 11 条
[1]  
[Anonymous], J CLIN ONCOL S
[2]   Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer [J].
Borghaei, H. ;
Paz-Ares, L. ;
Horn, L. ;
Spigel, D. R. ;
Steins, M. ;
Ready, N. E. ;
Chow, L. Q. ;
Vokes, E. E. ;
Felip, E. ;
Holgado, E. ;
Barlesi, F. ;
Kohlhaeufl, M. ;
Arrieta, O. ;
Burgio, M. A. ;
Fayette, J. ;
Lena, H. ;
Poddubskaya, E. ;
Gerber, D. E. ;
Gettinger, S. N. ;
Rudin, C. M. ;
Rizvi, N. ;
Crino, L. ;
Blumenschein, G. R. ;
Antonia, S. J. ;
Dorange, C. ;
Harbison, C. T. ;
Finckenstein, F. Graf ;
Brahmer, J. R. .
NEW ENGLAND JOURNAL OF MEDICINE, 2015, 373 (17) :1627-1639
[3]   Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer [J].
Brahmer, Julie ;
Reckamp, Karen L. ;
Baas, Paul ;
Crino, Lucio ;
Eberhardt, Wilfried E. E. ;
Poddubskaya, Elena ;
Antonia, Scott ;
Pluzanski, Adam ;
Vokes, Everett E. ;
Holgado, Esther ;
Waterhouse, David ;
Ready, Neal ;
Gainor, Justin ;
Aren Frontera, Osvaldo ;
Havel, Libor ;
Steins, Martin ;
Garassino, Marina C. ;
Aerts, Joachim G. ;
Domine, Manuel ;
Paz-Ares, Luis ;
Reck, Martin ;
Baudelet, Christine ;
Harbison, Christopher T. ;
Lestini, Brian ;
Spigel, David R. .
NEW ENGLAND JOURNAL OF MEDICINE, 2015, 373 (02) :123-135
[4]   Pseudoprogression and Immune-Related Response in Solid Tumors [J].
Chiou, Victoria L. ;
Burotto, Mauricio .
JOURNAL OF CLINICAL ONCOLOGY, 2015, 33 (31) :3541-+
[5]   Therapeutic efficacy of ipilimumab, an anti-CTLA-4 monoclonal antibody, in patients with metastatic melanoma unresponsive to prior systemic treatments: clinical and immunological evidence from three patient cases [J].
Di Giacomo, Anna Maria ;
Danielli, Riccardo ;
Guidoboni, Massimo ;
Calabro, Luana ;
Carlucci, Dora ;
Miracco, Clelia ;
Volterrani, Luca ;
Mazzei, Maria Antonietta ;
Biagioli, Maurizio ;
Altomonte, Maresa ;
Maio, Michele .
CANCER IMMUNOLOGY IMMUNOTHERAPY, 2009, 58 (08) :1297-1306
[6]   A clinical development paradigm for cancer vaccines and related biologics [J].
Hoos, Axel ;
Parmiani, Giorgio ;
Hege, Kristen ;
Sznol, Mario ;
Loibner, Hans ;
Eggermont, Alexander ;
Urba, Walter ;
Blumenstein, Brent ;
Sacks, Natalie ;
Keilholz, Ulrich ;
Nichol, Geoffrey .
JOURNAL OF IMMUNOTHERAPY, 2007, 30 (01) :1-15
[7]   Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies [J].
Naidoo, J. ;
Page, D. B. ;
Li, B. T. ;
Connell, L. C. ;
Schindler, K. ;
Lacouture, M. E. ;
Postow, M. A. ;
Wolchok, J. D. .
ANNALS OF ONCOLOGY, 2015, 26 (12) :2375-2391
[8]   Personalized Tumor Response Assessment in the Era of Molecular Medicine: Cancer-Specific and Therapy-Specific Response Criteria to Complement Pitfalls of RECIST [J].
Nishino, Mizuki ;
Jagannathan, Jyothi P. ;
Krajewski, Katherine M. ;
O'Regan, Kevin ;
Hatabu, Hiroto ;
Shapiro, Geoffrey ;
Ramaiya, Nikhil H. .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2012, 198 (04) :737-745
[9]  
SJAe al, 2015, J CLIN ONCOL, V33, P2015
[10]   Guidelines for the Evaluation of Immune Therapy Activity in Solid Tumors: Immune-Related Response Criteria [J].
Wolchok, Jedd D. ;
Hoos, Axel ;
O'Day, Steven ;
Weber, Jeffrey S. ;
Hamid, Omid ;
Lebbe, Celeste ;
Maio, Michele ;
Binder, Michael ;
Bohnsack, Oliver ;
Nichol, Geoffrey ;
Humphrey, Rachel ;
Hodi, F. Stephen .
CLINICAL CANCER RESEARCH, 2009, 15 (23) :7412-7420