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Cancer Treatment-Associated Pericardial Disease: Epidemiology, Clinical Presentation, Diagnosis, and Management

  • Pericardial Disease (AL Klein and CL Jellis, Section Editors)
  • Published:
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Abstract

Purpose of Review

Cancer therapeutics have seen tremendous growth in the last decade and have been effective in the treatment of several cancer types. However, with advanced therapies like kinase inhibitors and immunotherapies, there have been unintended consequences of cardiotoxicities. While traditional chemotherapy and radiation-induced cardiotoxicity have been well studied, further research is needed to understand the adverse effects of newer regimens.

Recent Findings

Both immune-mediated and non-immune-medicated cytotoxicity have been noted with targeted therapies such as tyrosine kinase inhibitors and immune checkpoint inhibitors. In this manuscript, we describe the pericardial syndromes associated with cancer therapies and propose management strategies. Pericardial effusion and pericarditis are common presentations in cancer patients and often difficult to diagnose. Concomitant myocarditis may also present with pericardial toxicity, especially with immunotherapies. In addition to proper history and physical, additional testing such as cardiovascular imaging and tissue histology need to be obtained as appropriate. Holding the offending oncology drug, and institution of anti-inflammatory medications, and immunosuppressants such as steroids are indicated.

Summary

A high index of suspicion, use of standardized definitions, and comprehensive evaluation are needed for early identification, appropriate treatment, and better outcomes for patients with cancer treatment-associated pericardial disease. Further research is needed to understand the pathophysiology and to evaluate how the management of pericardial conditions in these patients differ from traditional management and also evaluate new therapies.

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Funding

Dr. Moslehi is supported by NIH grants (R56 HL141166 and R01 HL141166).

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  1. Chandra K. Ala

    Present address: Department of Cardiology, Detroit Medical Center/Wayne State University, Detroit, MI, USA

Authors and Affiliations

  1. Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Chandra K. Ala

  2. Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Allan L. Klein

  3. Division of Cardiovascular Medicine, Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA

    Javid J. Moslehi

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Chandra K. Ala declares no conflict of interest.

Allan L. Klein reports he is on the steering committee for Sobi and Pfizer, and he is also supported by a research grant from Kiniksa.

Javid J. Moslehi reports he has been a consultant for Pfzier, Novartis, Bristol-Myers Squibb, Audentes, AstraZeneca, and Nektar.

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Ala, C.K., Klein, A.L. & Moslehi, J.J. Cancer Treatment-Associated Pericardial Disease: Epidemiology, Clinical Presentation, Diagnosis, and Management. Curr Cardiol Rep 21, 156 (2019). https://doi.org/10.1007/s11886-019-1225-6

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