Pulmonary toxicity in patients treated with immune checkpoint inhibitors and radiation

Senan, Suresh

doi:10.1016/j.annonc.2020.10.476

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…66 Recently, pulmonary toxicities occur earlier in patients with NSCLC than those with other tumors and are not predictive for better patient outcomes by contrast to other immune-related adverse events (irAEs). 67 Patients with immune-related pulmonary toxicities frequently present with relatively nonspecific symptoms, such as dyspnea, cough, chest discomfort, and/or infrequently fever. Chest X-ray or CT may reveal ground-glass opacities, findings consistent with organizing pneumonia, or interstitial pneumonia.…”

Section: Treatment Approach With Guidelinesmentioning

confidence: 99%

Immunotherapy for Lung Cancer

KARADURMUŞ,

AKYÜREK,

AYDINER

et al. 2023

J Oncol Sci

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ABS TRACT Lung cancer is one of the leading causes of cancer-related deaths in men and women. Similar to the approach with other cancer types, lung cancer staging is crucial in planning an effective treatment plan and predicting patient prognosis. Effective immunotherapies for patients with non-small cell lung cancer and non-genomic driver mutations are rapidly evolving. Moreover, anti-programmed death receptor-1 (PD-1)/programmed death ligand 1 (PD-L1)-based treatments have become the first-line standard of care. Despite shortcomings, PD-L1 expression level seems currently to be a relatively reliable predictor of the clinical efficacy of treatment with anti-PD-1/PD-L1 antibodies. However, additional biomarkers are required to better personalize treatment options for these patients. This review aimed to increase awareness of lung cancer and immunotherapy treatment options, depending on patient and disease stage characteristics.

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Section: Treatment Approach With Guidelinesmentioning

confidence: 99%

Immunotherapy for Lung Cancer

KARADURMUŞ,

AKYÜREK,

AYDINER

et al. 2023

J Oncol Sci

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“…Luckily, incidence of connective tissue diseases was found to be low with the use of PD-1/PD-L1 inhibitors. The incidence of irAEs also varies by ICI regimen, tumor type, disease setting and, possibly, ethnicity [34]. It may also differ with the drugs used, colitis and hypophysitis more common with CTL4 blockade and pneumonitis and thyroiditis with PD-1.…”

Section: Adverse Effectsmentioning

confidence: 99%

Pulmonary Toxicities of Immune Check Point Inhibitors in the Management of Cancer: Mini Review

Jayakrishnan¹,

Al-Moundhri²,

Burney³

et al. 2022

Advances in Respiratory Medicine

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“…Previous studies have reported sequelae ranging from mild airway narrowing [8] to fistula and necrosis and, in some cases, fatal events such as massive hemoptysis [5,[9][10][11][12]. With the growing use of SBRT for central lung tumors [3,[13][14][15], an increasing number of new targeted lung cancer treatments with unknown effects on irradiated tissues/interactions with radiation [15][16][17][18][19][20], and an improvement in prognosis (e.g., for patients with metastatic disease and certain driver mutations, and following the introduction of adjuvant immunotherapy for locallyadvanced disease), the incidence of these complications may rise in the future. Although radiation toxicity of the lung parenchyma has been studied extensively, relatively little has been published on bronchoscopic findings in the central airways and no standard classification/reporting system exists.…”

Section: Introductionmentioning

confidence: 99%

Late Central Airway Toxicity after High-Dose Radiotherapy: Clinical Outcomes and a Proposed Bronchoscopic Classification

Hoorn

Dahele

Daniëls

2021

Cancers

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The study’s purpose was to identify the bronchoscopic patterns of central airway toxicity following high-dose radiotherapy or chemoradiotherapy, and to look at the consequences of these findings. Our institutional bronchoscopy database was accessed to identify main patterns of airway toxicity observed in a seven-year period. A total of 70 patients were identified with central airway toxicity, and the findings of bronchoscopy were used to derive a classification system. Patient characteristics, time from radiotherapy to toxicity, follow-up and survival were retrospectively analyzed. Results: The main bronchoscopic patterns of airway toxicity were vascular changes (telangiectasia, loss of vascularity, necrosis) and stenosis of the lumen (moderate, severe). Indications for bronchoscopy were airway symptoms (n = 28), assessment post-CRT/surgery (n = 12), (suspected) recurrence (n = 21) or assessment of radiological findings (n = 9). Stenosis was revealed by bronchoscopy at a median time of 10.0 months (IQR: 4–23.5) after radiotherapy and subsequent follow-up after identification was 23 months (IQR: 1.5–55). The corresponding findings for vascular changes were 29 months (IQR: 10.5–48.5), and follow-up after identification was nine months (IQR: 2.5–19.5). There was a statistically significant difference in survival rates between patients with necrosis and telangiectasia (p = 0.002) and loss of vascularity (p = 0.001). Eight out of 10 deceased patients with telangiectasia died of other causes and 4/8 patients with necrosis died of other causes. We identified two main patterns of central airway toxicity visualized with bronchoscopy after high-dose radiotherapy or chemoradiotherapy, and propose a bronchoscopic classification system based on these findings. Preliminary analysis suggests that the pattern and severity of radiation damage might be of prognostic value. Prospective data are required to confirm our findings.

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Pulmonary toxicity in patients treated with immune checkpoint inhibitors and radiation

Cited by 4 publications

References 14 publications

Immunotherapy for Lung Cancer

Immunotherapy for Lung Cancer

Pulmonary Toxicities of Immune Check Point Inhibitors in the Management of Cancer: Mini Review

Late Central Airway Toxicity after High-Dose Radiotherapy: Clinical Outcomes and a Proposed Bronchoscopic Classification

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