Right Ventricular Metastasis From Cervical Cancer Treated With Pembrolizumab-Containing Chemotherapy: A Case Report and Literature Review.

BACKGROUND Cardiac metastasis from cervical cancer is extremely rare and associated with a poor prognosis. Given its rarity and the critical anatomical location of the lesion, optimal treatment strategies have not been established. We report a case of right ventricular metastasis from cervical squamous cell carcinoma that was treated with pembrolizumab-containing chemotherapy. CASE REPORT A 51-year-old woman with stage IB2 cervical squamous cell carcinoma underwent radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. Three years and 7 months after initial treatment, she developed heart failure due to cardiac tamponade. Echocardiography and computed tomography revealed a mass in the anterior wall of the right ventricle. Histopathological examination confirmed metastatic squamous cell carcinoma consistent with cervical cancer. Surgical resection was considered inappropriate given the risk of worsening heart failure and right ventricular dysfunction; radiotherapy was avoided because of potential cardiac toxicity. The patient received paclitaxel, carboplatin, and pembrolizumab every 3 weeks without bevacizumab due to the potential risk of cardiac perforation. After 6 cycles, the tumor diameter decreased from 57.3 mm to 28.7 mm. Cancer antigen 125 (CA125) decreased from 473 to 20 U/mL, and B-type natriuretic peptide decreased from 24.8 to 7.2 pg/mL. No adverse events were observed, and the patient was subsequently transitioned to maintenance pembrolizumab. CONCLUSIONS Pembrolizumab-containing chemotherapy may be a feasible treatment option for selected patients with cardiac metastasis from cervical cancer when surgery or radiotherapy is not appropriate. Further accumulation of cases is needed.