IMMUNE CHECKPOINT INHIBITORS
Section Editor
Barbara Rogers, CRNP, MN, AOCN®, ANP-BC
Fox Chase Cancer Center
Case Study
Nivolumab-Associated Pericarditis in a Patient With Non–Small Cell Lung Cancer
Diagnosis
NR is a 69-year-old male in good condition diagnosed with non–small cell lung cancer with a ECOG performance status of 0–1.
Treatment
He received chemotherapy with paclitaxel and carboplatin and was noted to have stable disease throughout the first four cycles. However, in the CT scan that was completed after six cycles, he was noted to have experienced disease progression. NR then received nivolumab.
Cardiotoxicity Mitigation and Management
Five days after his 24th cycle of single-agent nivolumab, he reported having dyspnea and having a fever. Upon physical exam, he was noted to have a heart rate of 120 bpm. An electrocardiogram was obtained that indicated elevated ST segment in all leads but aVR. His erythrocyte sedimentation rate and C-reactive protein were both elevated (100 and 180, respectively). Troponin was normal. An echocardiogram was obtained that demonstrated pericarditis.
The nivolumab was stopped, NR was started on prednisone 1 mg/kg for 2 weeks, and then was gradually tapered over the next 8 weeks. He had full clinical recovery. His disease was under control at that time, so the plan was to leave him off therapy and monitor for progression of his disease.
Meet the Faculty
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Immune Checkpoint Inhibitors Managing Cardiotoxicity Associated With Immune Checkpoint Inhibitor Therapy
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Immune Checkpoint Inhibitors Immune Checkpoint Inhibitors and Cardiotoxicity: Incidence and Patient Risk Factors
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Immune Checkpoint Inhibitors Immune Checkpoint Inhibitors and Cardiotoxicity: The Pharmacist Perspective
