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Immune checkpoint inhibitors-associated pericardial disease: a systematic review of case reports

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Abstract

Treatment with immune checkpoint inhibitors (ICIs) can be complicated by cardiovascular toxicity, including pericardial disease. To date, no prospective studies specifically investigated the optimal treatment of ICI-associated pericardial disease, and the available evidence is based on case reports and series only. We performed a systematic review of case reports and series including 20 publications for a total of 28 cases of ICI-associated pericardial disease. In this review, pericardial disease was reversible in the majority of cases (75%), although 2 deaths were reported. The majority of cases were life-threatening (G4, 53.6%) or severe (G3, 21.4%), requiring pericardiocentesis. Higher rates of improvement were associated with administration of corticosteroids (86.7% vs 61.5%), presence of other immune-related adverse events (90.9% vs. 64.7%), and non-malignant effusions (86.7% vs 42.8%). ICIs were discontinued in the majority of cases and then restarted in 7 patients with no recurrence of pericardial disease. Based on these results, ICI-associated G3–G4 pericardial disease as well as G2 pericardial disease with moderate–severe effusion should be treated with ICIs discontinuation and high-dose steroids, also performing pericardiocentesis, pericardial drainage or pericardial window in case of cardiac tamponade. For G2 with small effusion or G1 pericardial disease, ICIs might be continued and colchicine or NSAIDs could be considered. For patients requiring ICIs discontinuation, a rechallenge with ICIs seems to be feasible after resolution or meaningful improvement of pericardial disease.

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Authors and Affiliations

  1. Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Via don A. Sempreboni 5, 37024, Negrar di Valpolicella, Verona, Italy

    Alessandro Inno & Stefania Gori

  2. Divisione di Cardiologia, IRCCS Fondazione G. Pascale, Napoli, Italy

    Nicola Maurea & Andreina Carbone

  3. Oncologia Medica, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera Di Perugia, Perugia, Italy

    Giulio Metro

  4. Oncologia Medica, Dipartimento di Discipline Chirurgiche, Oncologiche E Stomatologiche, Policlinico Universitario “A. Giaccone”, Palermo, Italy

    Antonio Russo

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  1. Alessandro Inno
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Correspondence to Alessandro Inno.

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Inno, A., Maurea, N., Metro, G. et al. Immune checkpoint inhibitors-associated pericardial disease: a systematic review of case reports. Cancer Immunol Immunother 70, 3041–3053 (2021). https://doi.org/10.1007/s00262-021-02938-z

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  • DOI: https://doi.org/10.1007/s00262-021-02938-z

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