Chinese expert consensus on the multidisciplinary management of pneumonitis associated with immune checkpoint inhibitor

Wang, Wenxian; Wang, Qian; Xu, C.; Li, Ziming; Song, Zhengbo; Zhang, Yongchang; Zhang, Shirong; Lian, Bin; Li, Wen; Liu, Anwen; Zhan, Ping; Liu, Hongbing; Lv, Tangfeng; Miao, Liyun; Min, Lingfeng; Chen, Yu; Yuan, Jingping; Wang, Feng; Jiang, Zhansheng; Lin, Gen; Pu, Xingxiang; Rao, Chuangzhou; Lv, Dongqing; Yu, Zhen; Li, Xiaoyan; Tang, Chuanhao; Zhou, Chengzhi; Xie, Congying; Zhang, Junping; Guo, Hui; Chu, Qian; Meng, Rui; Wu, Jingxun; Zhang, Rui; Wang, Liping; Zhu, You‐cai; Hu, Xiao; Xie, Yanru; Lin, Xinqing; Cai, Jing; Lan, Fen; Feng, Huijing; Wang, Lin; Wang, Yao; Shi, Xuefei; Huang, Jian; Chen, Huafei; Zhang, Yinbin; Sun, Ping‐Li; Wan, Bing; Pang, Fei; Xu, Zanmei; Wang, Kai; Xia, Yuanli; Ye, Mingxiang; Wang, Dong; Wei, Qing; Feng, Shuitu; Zhou, Jianya; Zhang, Jiexia; Lv, Donglai; Gao, Wenbin; Kang, Jing; Yu, Genhua; Liang, Xiao; Yu, Caoyang; Lin, Shi; Yang, Nong; Wu, Lin; Hong, Zhuan; Hong, Wei; Fang, M.; Zhang, Yiping; Lu, Yuanzhi; Wang, Guansong; Ma, Shenglin; Si, Lu; Fang, Wenfeng; Song, Yong

doi:10.1111/1759-7714.14693

Cited by 9 publications

(6 citation statements)

References 84 publications

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“…Steroid refractory is defined as no clinical improvement and worsening of clinical course after the initiation of steroid therapy in patients with immune pneumonitis, while steroid resistance is the recurrence of immune pneumonitis with the gradual tapering of steroids that initially responds to steroid therapy. 47 In our study, additional mycophenolate mofetil was considered for one steroid-refractory patient, mycophenolate mofetil for one of the two steroid-refractory patients, and infliximab was prescribed for another patient. These three patients benefited from additional immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 98%

Clinical and Radiological Features and Treatment of Pulmonary Toxicity Associated with Using Immune Checkpoint Inhibitors in Cancer Treatment: A Single-Center Experience

GÖKMEN,

GÖKYER,

AKGÜL

et al. 2023

J Oncol Sci

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Immune checkpoint inhibitors (ICIs) are monoclonal antibodies and include cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death-1 (PD-1), and programmed cell death ligand-1 (PD-L1), which are becoming increasingly important in cancer treatment. 1 ICIs exert their anti-tumoral activity by increasing the activity of the immune system, especially T cells. 2 The United States Food and Drug Administration has approved many ICIs; for example, ipilimumab, an anti-CTLA-4 antibody, was the first agent approved in 2011 for melanoma patients. 3 PD-1 is targeted by pembrolizumab, nivolumab, and cemiplimab, while atezolizumab, durvalumab, and avelumab target PD-L1. They have been introducedfor the treatment of many solid and liquid cancers, such as malignant melanoma, non-small cell lung cancer (NSCLC), renal cell carcinoma, and cancers with impaired DNA damage repair (MSI-high). 4 More than 233,000 patients receive these agents annually as first-or next-line therapy. 5 ICIs are associated with several adverse events different from those of other conventional systemic therapies, such as cytotoxic chemotherapy, including decreased T-cell tolerance and uncontrolled activation of immunity, with unknown pathophysiology. 6 Although these adverse events can affect many organs and mostly the skin, they may affect the thyroid, adrenal, and pituitary glands, gastrointestinal tract, lung, kidney,

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Section: Discussionmentioning

confidence: 98%

Clinical and Radiological Features and Treatment of Pulmonary Toxicity Associated with Using Immune Checkpoint Inhibitors in Cancer Treatment: A Single-Center Experience

GÖKMEN,

GÖKYER,

AKGÜL

et al. 2023

J Oncol Sci

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“…In accordance with the expert consensus from China on CIP [ 12 ], the diagnostic criteria for this condition involve a documented history of ICIs usage, followed by the emergence of specific clinical symptoms such as cough, chest pain, fever, or hypoxemia. Additionally, it is imperative to demonstrate the emergence of novel pulmonary abnormalities via imaging modalities, whilst meticulously excluding other plausible differential diagnoses such as pulmonary infections, tumor progression, pulmonary edema, and thromboembolic events.…”

Section: Methodsmentioning

confidence: 99%

Risk factors of immune checkpoint inhibitor-related pneumonitis after neoadjuvant immunochemotherapy for resectable NSCLC

Mao,

Pang,

Huang

et al. 2024

BMC Pulm Med

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Background The incidence of checkpoint inhibitor-associated pneumonitis (CIP) in advanced non-small cell lung cancer (NSCLC) has been substantiated through large-scale clinical trials or real-world studies. However, reports on CIP incidence within the context of neoadjuvant immunotherapy for resectable NSCLC remain scarce. This study endeavors to investigate the incidence, risk factors, and outcomes of CIP in patients with resectable NSCLC receiving neoadjuvant immunochemotherapy. Methods A retrospective, case-control study was conducted on patients diagnosed with NSCLC stages IIA–IIIB who received neoadjuvant immunochemotherapy between January 2018 and September 2022. Patients were stratified into two groups based on the presence or absence of CIP, facilitating a comparative analysis of clinical characteristics, treatment modalities, physiological indicators, and prognostic outcomes . Results The study cohort comprised 245 patients, with 11.4% (28/245) experiencing CIP. The median period of CIP onset was 70 (range, 40–221) days. The incidence of severe CIP (grade 3–4) was 3.7% (9/245). Patients with CIP showed a higher all-cause mortality rate of 21.4% (6/28) compared to that of patients without CIP. Those who developed CIP exhibited elevated body mass index (BMI) values (p = 0.028) and increased fibrinogen (FIB) levels (p < 0.001), alongside a significant decrease in both diffusing capacity for carbon monoxide (DLCO)% pred (p = 0.001) and DLCO/VA% pred (p = 0.021) after neoadjuvant therapy compared to pre-indicators. Receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve of three assessed variables (FIB levels, BMI, DLCO) reached 0.806 in predicting CIP occurrence at an early stage. Conclusions This cohort demonstrated that elevated BMI, increased FIB levels, and decreased pulmonary diffusion function after neoadjuvant therapy are risk factors of CIP occurrence. Early assessment and continuous monitoring of these indicators are imperative for the predictive identification of CIP, enhancing patient management and outcomes.

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“…Several studies have demonstrated a clear link between the incidence of chemotherapyinduced peripheral neuropathy (CIP) and the use of combination therapy, as well as immuno-targeted or radiotherapy or a combination of two immune agents [9]. The severity of CIP is classified into grades 1-5, with slight differences between the standards of ESMO and NCCN [10]. Treatment protocols are developed based on these grades, and corresponding recommendations are provided for each grade.…”

Section: Checkpoint Inhibitor Pneumonitis (Cip)mentioning

confidence: 99%

Side Effects and Research Progress of Immune Checkpoint Inhibitors

2024

TMBLS

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Immune checkpoint inhibitor (ICI) is a new type of tumor treatment drug, also known as immunotherapy drug. They target "checkpoint" molecules in the body's immune system that prevent immune cells from attacking cancer cells. They target "checkpoint" molecules in the body's immune system that prevent immune cells from attacking cancer cells. The use of immune checkpoint inhibitors can help control or treat certain types of cancer by promoting the restoration of inactivated immune cells and enhancing the immune system's ability to attack. -This article focuses on skin reactions, immune pneumonitis, and adverse reactions in the thyroid and digestive tract. Through the analysis of recent relevant research, this question summarizes several different side effects, their causes and treatments. Although there are many treatments to deal with the side effects of this drug, it is important to note that the side effects of this drug are not always well understood. There are many treatments to deal with the related side effects, these side effects are still a barrier to the current use of ICIs. Future development directions should focus more on the development of ICIs. directions should focus more on the development of new targets, optimization of drug pharmacokinetics, and alleviation of side effects caused by ICIs.

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Chinese expert consensus on the multidisciplinary management of pneumonitis associated with immune checkpoint inhibitor

Cited by 9 publications

References 84 publications

Clinical and Radiological Features and Treatment of Pulmonary Toxicity Associated with Using Immune Checkpoint Inhibitors in Cancer Treatment: A Single-Center Experience

Clinical and Radiological Features and Treatment of Pulmonary Toxicity Associated with Using Immune Checkpoint Inhibitors in Cancer Treatment: A Single-Center Experience

Risk factors of immune checkpoint inhibitor-related pneumonitis after neoadjuvant immunochemotherapy for resectable NSCLC

Side Effects and Research Progress of Immune Checkpoint Inhibitors

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