Literature cases analysis of cardiotoxic reactions due to nivolumab
10.3760/cma.j.issn.1008-5734.2019.02.006
- VernacularTitle:纳武利尤单抗心脏毒性反应文献病例分析
- Author:
Man DUAN
1
;
Qiuming HUANG
1
Author Information
1. 武汉科技大学附属孝感医院药学部,湖北省孝感市,432000
- Publication Type:Journal Article
- Keywords:
Immunotherapy;
Heart;
Drug-related side effects and adverse reactions;
Nivolumab
- From:
Adverse Drug Reactions Journal
2019;21(2):102-107
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical characteristics of cardiotoxic reactions induced by nivolumab.Methods CNKI,VIP,Wanfang,PubMed,Web of Science and MEDLINE databases were searched up to September 2018.The literature containing cases on cardiotoxic reactions induced by nivolumab was collected,relevant information was extracted,and the clinical characteristics of cardiotoxic reactions induced by nivolumab were analyzed.Results A total of 22 patients enrolled in the study,including 13 males and 9 females,aged 35-80 years,of them,70.3％ (17 cases) patients were ＞ 60 years old.Primary diseases of the patients included malignant melanoma (9 patients),lung adenocarcinoma (6 patients),squamous cell carcinoma of lung (2 patients),type B3 thymoma (1 patient),non-small-cell lung cancer (1 patient),Merkel cell carcinoma (1 patient),uveal melanoma (1 patient),and clear cell renal cell carcinoma (1 patient).There were 6,1,1,and 4 patients with history of hypertension,cardiac pacemaker implantation,pseudo bundle branch block syndrome,and targeted therapy with tyrosine kinase inhibitor,respectively.Of the 22 patients,15 patients received nivolumab monotherapy,6 patients received combination therapy with nivolumab and ipilimumab,and one patient received 3 months' ipilimumab before nivolumab.There were 2 patients received nivolumab without reasonable dosage and frequency according to the specifications,and 10 patients with missing information of drug dosage and frequency.Cardiotoxic reactions appeared 47 times totally in the 22 patients,mainly including myocarditis (13 times),heart block (6 times),pericardial effusion (5 times),and etc.,and mainly performing as the clinical characteristics of pectoralgia,dyspnea,anhelation,and fatigue.Cardiotoxic reactions first appeared on the 4th day and lastly on the 327th day after the initial dose.After the appearance of cardiotoxic reactions,nivolumab were stopped immediately in 20 patients and after the reactions improved in 1 patient,while intermittent medication was conducted in another 1 patient.Of the 22 patients,17 received symptomatic treatments,4 received pacemaker implantation,18 received high-dose glucocorticoid shock therapy,and 6 received immunotherapy.Of the 22 patients,9 (40.9％) died,12 had improved symptoms,and 1 had unknown prognosis.Conclusions The cardiotoxic reactions induced by nivolumab were characterized by dispersed incubation period and higher mortality.The symptomatic treatments and high-dose glucocorticoid treatment have a certain positive effects.
