Nivolumab
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Pericardial effusion: case report A 72-year-old woman developed pericardial effusion during chemotherapy with nivolumab for renal cell carcinoma. The woman presented with chest discomfort, malaise and loss of appetite. In April 2015, she had undergone manual laparoscopic left nephrectomy and lymph node dissection for left renal cell carcinoma, lymph node metastasis and bone metastases. Post-operatively, she had received adjuvant chemotherapy comprising temsirolimus, sunitinib and pazopanib. However, the disease progressed. Therefore, from November 2017, she started receiving nivolumab 3 mg/kg, every 2 weeks [route not stated]. During administration of fifth cycle of nivolumab, she was admitted due to chest discomfort and appetite loss. She had BP of 162/108mm Hg. CT scan revealed pericardial effusion, which was not observed in the CT scan performed prior to initiation of nivolumab. After excluding other possible causes of pericardial effusion, pericardial effusion was attributed to nivolumab. On the hospitalisation day 2, pericardiocentesis was performed and a drain was placed. The pericardial fluid was dark red and exudative in characteristic. Biochemical examination of pericardial fluid showed pH of 8, total protein of 5 g/dL, sugar of 91 mg/dL and LDH of 1794 U/L. Bacterial culture test of the pericardial fluid was negative. Cytological analysis of the pericardial effusion showed only leucocytes and no malignant cells. The drainage decreased on hospitalisation day 3 and it was pale in colour. Therefore, the drain was removed. After improvement in her symptoms, the woman was discharged on hospitalisation day 8. A CT scan performed after 2 weeks from the discharge showed no replenishment of pericardial fluid. Even though shebecame stable on nivolumab, nivolumab therapy was switched to axitinib. Author comment: "[I]n our case, we speculated that it was not only pericardial effusion due to decreased thyroid function, but that pericardial effusion was likely due to an [immune-related adverse events] caused by nivolumab administration." Fukae S, et al. [A Case of Pericardial Effusion Induced by Nivolumab for Metastatic Renal Cell Carcinoma]. Hinyokika Kiyo 65: 329-332, No. 8, 31 Aug 2019. Available from: URL: http://doi.org/10.14989/ActaUrolJap_65_8_329 803434502 [Japanese; summarised from a translation] - Japan
0114-9954/19/1780-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 23 Nov 2019 No. 1780
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