Checkpoint Inhibitor Pneumonitis Induced by Programmed Death-1 Antibody: A Case Report and Literature Review

Abstract

Immune Checkpoint Inhibitors (ICIs) are effective treatment therapies for majority advanced tumours. However, the immune-related Adverse Events (irAEs) triggered by ICIs may affect human organs, including skin, lungs, pituitary, thyroid, blood and digestive system, leading to immunotoxicity in these organs. Checkpoint Inhibitor Pneumonitis (CIP) is one of the irAEs that could cause mortality, thereby needs special attention from the clinical physicians. In the present manuscript, the CIP occurred in a unilateral lung in one patient case with advanced oesophageal cancer treated with anti-PD-1 was analysed. Furthermore, a literature review was conducted to investigate its pathogenesis, clinical features, associated risk factors, prevention and the correlation with ICI efficacy, providing valuable information for clinical physicians.

A retrospective study of combination therapy with glucocorticoids and pirfenidone for PD-1 inhibitor-related immune pneumonitis

“…[10] As stated previously, pirfenidone is considered to apply in ICIP because of its antifibrotic and anti-inflammatory effect. [13][14][15][16][17] This was retrospective study of PD-1 inhibitor-associated ICIP in NSCLC patients. The combination of pirfenidone and traditional corticosteroid therapy in ICIP patients has advantages in improving symptoms and level of activity.…”

“…The efficacy pirfenidone is validated in patients with mild-to-moderate impairment of pulmonary functions with adverse events such as photosensitivity and anorexia; the efficacy in patients with severe impairment is not confirmed, but the treatment is demonstrated to be well tolerated. [16] According to the study by Yu et al, [17] a patient with grade 3 ICIP was treated with an initial high-dose glucocorticoid pulse and oral pirfenidone (300 mg thrice-daily) for > 11 months, and the patient demonstrated a considerable improvement based on computed tomography imaging and clinical symptoms.…”