Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis

Abstract

Immune checkpoint inhibitors, including cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1) inhibitors, represent an effective treatment modality for multiple malignancies. Despite the exciting clinical benefits, checkpoint inhibition is associated with a series of immune-related adverse events (irAEs), many of which can be life-threatening and result in significant treatment delays. Pneumonitis is an adverse event of special interest as it led to treatment-related deaths in early clinical trials. This review summarizes the incidence of pneumonitis during treatment with the different checkpoint inhibitors and discusses the prognostic significance of tumor type. The wide range of clinical, radiographic, and histologic characteristics of checkpoint inhibitor-related pneumonitis is reviewed and followed by guidance on the different management strategies.

Imaging of tumour response to immunotherapy

“…Pneumonitis is an autoimmune toxicity with a wide range of clinical course, ranging from mild dyspnoea to life-threatening respiratory failure [60], with up to 2% of patients developing severe pneumonitis [38]. Unlike the majority of irAEs, it is less common with anti-CTLA-4 monotherapy than with anti-PD-1 treatment [38,60].…”

“…Pneumonitis is an autoimmune toxicity with a wide range of clinical course, ranging from mild dyspnoea to life-threatening respiratory failure [60], with up to 2% of patients developing severe pneumonitis [38]. Unlike the majority of irAEs, it is less common with anti-CTLA-4 monotherapy than with anti-PD-1 treatment [38,60]. It occurs in up to 5% of patients receiving anti-PD1 and anti-PDL1, while it arises in 10% of patients receiving combination treatment [38,60,61], with higher odds of pneumonitis in non-small cell lung cancer compared with melanoma [61][62][63].…”

A case of pembrolizumab‐induced localized organizing pneumonia

“…However, they are associated with several immune-related adverse events (IRAEs). 1 These adverse events include hypophysitis, thyroiditis, myositis, colitis, dermatitis and pneumonitis; however, organizing pneumonia is not a common IRAE, and review of the literature thus far has only identified one case report of such a reaction. 2 While IRAEs can result in morbidity as well as treatment delay, emerging data indicate that they may also correlate with treatment response.…”

Managing Pulmonary Toxicities Associated with Immunotherapy: A Case Discussion

“…The median time to onset of pneumonitis was 57 days with a considerable range . The fact that this wide of a range was also observed in additional studies underscores the constant vigilance required to monitor for toxicities at any point during the course of therapy (and even after therapy is completed) [8,9,15,18,19]. Immune checkpoint blockade with anti-CTLA-4 and anti-PD-1 has been shown to be a highly effective combination with U.S. Food and Drug Administration approvals in melanoma and renal cell carcinoma.…”