Key result
A 62-year-old male with stage IV lung adenocarcinoma developed cardiac tamponade after five cycles of pembrolizumab, which resolved following drug discontinuation, pericardial window, and prednisone.
Why the study?
Immunotherapy drugs are associated with a multitude of immune-related adverse events.
Case Report (n=1)
Pembrolizumab can cause severe immune-related adverse events such as large pericardial effusion and cardiac tamponade, which can be successfully managed with drug discontinuation, pericardial window, and corticosteroids.
Alerts clinicians to possible pembrolizumab-associated tamponade; leaves open questions on incidence and prevention in lung cancer immunotherapy.
Immunotherapy drugs are associated with a multitude of immune-related adverse events. We describe a case of cardiac tamponade in a patient with stage IV lung adenocarcinoma, with almost 100% expression of PDL-1, treated with pembrolizumab. The patient is a 62-year-old male who developed worsening shortness of breath after five cycles of pembrolizumab. He was diagnosed with large pericardial effusion on computed tomography chest. Echocardiogram confirmed tamponade physiology. He was treated with discontinuation of pembrolizumab and urgent pericardial window followed by high dose prednisone with tapering. The patient responded very well to the treatment. We have comprehensively reviewed cases of pericardial effusion secondary to either immune mediated mechanisms or pseudoprogression.
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Khan et al. (2019) conducted a case report in Stage IV lung adenocarcinoma with cardiac tamponade (n=1). Pembrolizumab was evaluated on Cardiac tamponade. A 62-year-old male with stage IV lung adenocarcinoma developed cardiac tamponade after five cycles of pembrolizumab, which resolved following drug discontinuation, pericardial window, and prednisone.
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