Systematic Review

PD-1/L1 inhibitors may increase the risk of pericardial disease in non-small-cell lung cancer patients: a meta-analysis and systematic review

https://orcid.org/0000-0002-6462-1688

First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

‡These authors contributed equally as co-first authors

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Deting Han‡

Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China

‡These authors contributed equally as co-first authors

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Lei Zhang

First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

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Xiaoteng Feng

Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

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Huijie Li

Department of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

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Feiran Yang

First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

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Lucheng Song

Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China

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Xiurong Li

*Author for correspondence:

E-mail Address: szylxr2012@126.com

Department of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

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Published Online:4 Apr 2022https://doi.org/10.2217/imt-2021-0223

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Abstract

Background: The advent of PD-1/L1 inhibitors has changed the landscape for patients with non-small-cell lung cancer (NSCLC). Meanwhile, the adverse events of PD-1/L1 inhibitors have been focused. Methods: The Cochrane Central Register of Controlled Trials, PubMed and Embase databases and ClinicalTrials.gov were searched from inception to February 2021. Results: 18 studies involving 11,394 patients with NSCLC were included. PD-1/L1 inhibitor monotherapy was associated (relative risk, 95% confidence interval) with an increased risk of pericardial effusion (2.72 [1.45–5.12]; p = 0.002) and cardiac tamponade (2.76 [1.15–6.62]; p = 0.023), whereas PD-1/L1 inhibitors combined with chemotherapy did not increase the risk of pericardial effusion and cardiac tamponade (3.08 [0.93–10.21]; p = 0.066 and 3.27 [0.37–28.94]; p = 0.288, respectively). Conclusion: For patients with NSCLC, treatment with PD-1/L1 inhibitor monotherapy increases the risk of pericardial effusion and cardiac tamponade, but PD-1/L1 inhibitors combined with chemotherapy do not.

Plain language summary

In this study, the authors found that the incidence of pericardial effusion and cardiac tamponade in non-small-cell lung cancer patients treated with PD-1/L1 inhibitors was 0.63% and 0.35%, respectively, and in chemotherapy was 0.07% and less than 0.01%, respectively. The authors found that PD-1/L1 inhibitors combined with chemotherapy did not increase the risk of cardiac adverse events (AEs); however, the risk of cardiac AEs with PD-1/L1 inhibitor monotherapy should be considered, and the damage of pembrolizumab to the pericardium needs further attention. The mechanism of pericardial effusion and cardiac tamponade is not well understood, and pseudoprogression cannot be ruled out. Although the incidence of cardiac AEs is low, the prevention and management of immunotherapy should be paid attention to.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 14, No. 7

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History

Received 13 August 2021

Accepted 18 March 2022

Published online 4 April 2022

Published in print May 2022

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Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/imt-2021-0223

Author contributions

Honglin Li, Lei Zhang and Deting Han were responsible for investigation; Honglin Li and Deting Han were responsible for methodology and software; Honglin Li, Deting Han, Lucheng Song and Xiurong Li were responsible for supervision; Honglin Li, Deting Han, Lei Zhang, Xiaoteng Feng, Feiran Yang, Huijie Li and Lucheng Song were responsible for validation; Honglin Li and Deting Han were responsible for writing the original draft; Honglin Li, Deting Han, Lei Zhang, Lucheng Song and Xiurong Li were responsible for final approval of the version to be published.

Financial & competing interests disclosure

This work was supported by the Natural Science Foundation of Shandong Province, China (ZR2021LZY029). The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

English language editing was provided by Charlesworth Author Services.

Ethical conduct of research

The data in the meta-analysis were retrieved from completed and published clinical trials; therefore, ethical review and patient informed consent were not required.

Data sharing statement

All data generated or analyzed during this study are included in ClinicalTrials.gov

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