Multicenter retrospective study of efficacy and safety of immunotherapy in patients with advanced NSCLC and pericardial effusions

There are limited data available on immune checkpoint inhibitor (ICI) use in patients with non-small cell lung cancer (NSCLC) and known pericardial effusion. A retrospective study at 13 centers evaluated efficacy and safety of ICIs in 1248 patients with advanced NSCLC with (n=85) or without (n=1163) pre-existing pericardial effusions. Compared to controls, patients with pericardial effusions were younger (median age 63 versus 67 years; p=0.007), diagnosed more frequently with PD-L1 positive tumors (96% versus 76%; p<0.001), and had a higher median number of baseline metastatic sites (3 versus 1; p<0.001). Immune-related adverse events (irAEs) were similar between groups (42% versus 38%), and no cardiac irAEs occurred in the group with pericardial effusions. Progression-free survival (median 5.6 versus 4.6 months; p=0.3) and overall survival (median 10.2 versus 14.7 months; p=0.50) were not statistically different between patients with pericardial effusions and controls. In both multivariable and IPTW models, pericardial effusions were not associated with PFS or OS. The authors conclude that among patients with advanced NSCLC and pre-existing pericardial effusions, ICIs demonstrated no worse outcomes compared to those without effusions (graphical abstract).