Pembrolizumab-induced Radiation Recall Pneumonitis After the Resolution of Typical Asymptomatic Radiation Pneumonitis

Itamura, Hirohide; Ohguri, Takayuki; Yahara, Katsuya; Nakahara, Sota; Kakinouchi, Sho; Morisaki, Takahiro; Yatera, Kazuhiro; Tanaka, Fumihiro; Korogi, Yukunori

doi:10.7888/juoeh.42.261

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…Possible mechanisms of this type of pneumonia include stem cell function changes in the irradiated field triggered by hypersensitivity reactions to an idiosyncratic drug (119). Some case reports have presented radiation recall pneumonia in patients with NSCLC after treatment with ICIs (60,85). Patients who receive RT and develop new pulmonary changes demarcated from the adjacent lung in the initial radiation field should be preferentially suspected of having radiation recall pneumonia.…”

Section: Imaging Manifestationsmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management

et al. 2021

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Immunotherapy that includes programmed cell death-1 (PD-1), programmed cell death- ligand 1 (PD-L1) and cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitors has revolutionized the therapeutic strategy in multiple malignancies. Although it has achieved significant breakthrough in advanced non-small cell lung cancer patients, immune-related adverse events (irAEs) including checkpoint inhibitor pneumonitis (CIP), are widely reported. As the particularly worrisome and potentially lethal form of irAEs, CIP should be attached more importance. Especially in non-small cell lung cancer (NSCLC) patients, the features of CIP may be more complicated on account of the overlapping respiratory signs compromised by primary tumor following immunotherapy. Herein, we included the previous relevant reports and comprehensively summarized the characteristics, diagnosis, and management of CIP. We also discussed the future direction of optimal steroid therapeutic schedule for patients with CIP in NSCLC based on the current evidence.

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Section: Imaging Manifestationsmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management

et al. 2021

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“…After the resolution of radiation-induced pneumonitis, radiation recall pneumonitis, an acute inflammatory reaction in a previously irradiated area of the lung triggered by other anticancer drugs can occur (40). In a case report by Itamura et al, the patient developed radiation recall pneumonitis one month after initiating pembrolizumab, who had previously recovered from radiation pneumonitis (41).…”

Section: Radiotherapymentioning

confidence: 99%

Immune checkpoint inhibitor-related interstitial lung disease in patients with advanced non-small cell lung cancer: systematic review of characteristics, incidence, risk factors, and management

Kim¹,

Lim²

2022

J Thorac Dis

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Background: Immune checkpoint inhibitors (ICIs) are widely used in cancers with or without other treatments. Immune-related adverse events (irAEs) have been reported as side effects of ICIs and involve various organs. Pneumonitis, which is also called ICI-related interstitial lung disease (ILD), is one of the lifethreatening adverse events. In this report, we reviewed the safety of ICIs and risk factors for ICI-related ILD in non-small cell lung cancer (NSCLC) patients.Methods: Databases (The National Center for Biotechnology Information, PubMed, Cochrane Library, Google Scholar, and Embase) were searched for the literature on pulmonary adverse events and immunotherapy following PRISMA guidelines. All studies published in English between January 2016 and June 2021 were included.Results: One-hundred twenty-five articles were included at final. Pre-existing ILD as well as asthma and chronic obstructive lung disease (COPD) were associated with high risk for the development of ICI-related ILD, however, it did not affect the prognosis. The treatment of ICI-related ILD is different according to the severity grades, which includes discontinuation of ICI, corticosteroids, and for steroid-refractory ILD, other immunosuppressants. Rechallenging of ICI should be carefully considered in selected patients.Discussion: Patients with pre-existing lung disease and poor lung function need more attention for the development of ICI-related ILD. It is necessary to be aware of clinical manifestation of ICI-related ILD with prompt management.

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“…In the MDACC study, two patients with simultaneous HFRT or SBRT combined with PD-1 inhibitor had Grade 4 adverse effects, which may be attributed to the simultaneous medication. A study by ESMO 2020 showed that the administration of anti-PD-1 drugs before or during radiotherapy for thoracic tumours increased the incidence of radiation pneumonitis (60% 28%, P = 0.01) compared with the administration of anti-PD-1 drugs after radiotherapy ( 55 , 56 ). However, the occurrence of adverse effects is closely related to factors such as radiotherapy dose, volume and location.…”

Section: Efficacy Of Different Combinations Of Radiotherapy and Pd-1/pd-l1mentioning

confidence: 99%

The Research Progress of PD-1/PD-L1 Inhibitors Enhancing Radiotherapy Efficacy

Tong

Zhang

et al. 2021

Front. Oncol.

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Approximately 60%–70% of patients with malignant tumours require radiotherapy. The clinical application of immune checkpoint inhibitors (ICIs), such as anti-PD-1/PD-L1, has revolutionized cancer treatment and greatly improved the outcome of a variety of cancers by boosting host immunity.However, radiotherapy is a double-edged sword for PD-1/PD-L immunotherapy. Research on how to improve radiotherapy efficacy using PD-1/PD-L1 inhibitor is gaining momentum. Various studies have reported the survival benefits of the combined application of radiotherapy and PD-1/PD-L1 inhibitor. To fully exerts the immune activation effect of radiotherapy, while avoiding the immunosuppressive effect of radiotherapy as much as possible, the dose selection, segmentation mode, treatment timing and the number of treatment sites of radiotherapy play a role. Therefore, we aim to review the effect of radiotherapy combined with anti-PD-1/PD-L1 on the immune system and its optimization.

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Pembrolizumab-induced Radiation Recall Pneumonitis After the Resolution of Typical Asymptomatic Radiation Pneumonitis

Cited by 10 publications

References 16 publications

Immune Checkpoint Inhibitor-Associated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management

Immune Checkpoint Inhibitor-Associated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management

Immune checkpoint inhibitor-related interstitial lung disease in patients with advanced non-small cell lung cancer: systematic review of characteristics, incidence, risk factors, and management

The Research Progress of PD-1/PD-L1 Inhibitors Enhancing Radiotherapy Efficacy

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