Delayed toxicities with anti-PD-1 and anti-PDL-1 immune checkpoint inhibitors (ICIs).

Shah, Neil; Barbara, Tolusso; Kelly, William; Belouali, Anas; Serzan, Michael T.; Gonzalez, Sebastian Ochoa; Colton, Bradley; Janni, M.; Knoedler, Alice R.; Blackburn, Matthew; Puthiamadathil, Jeevan; Madhavan, Subha; Kumar, Pallavi; Liu, Stephen V.; Gibney, Geoffrey T.; Atkins, Michael B.

doi:10.1200/jco.2018.36.15_suppl.e15074

Cited by 9 publications

(6 citation statements)

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“…Medical oncologists should obtain surgical consultation early in their treatment course for patients with a tenuous airway or vascular encasement, even in the setting of clinical response to immunotherapy. Clinicians should be aware that delayed irAEs may occur months after discontinuation of immunotherapy and patients should be observed for such toxicities indefinitely [104–107].…”

Section: Key Clinical Questionsmentioning

confidence: 99%

The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC)

Cohen¹,

Bell²,

Bifulco³

et al. 2019

j. immunotherapy cancer

482

422

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Head and neck cancers, including those of the lip and oral cavity, nasal cavity, paranasal sinuses, oropharynx, larynx and nasopharynx represent nearly 700,000 new cases and 380,000 deaths worldwide per annum, and account for over 10,000 annual deaths in the United States alone. Improvement in outcomes are needed for patients with recurrent and or metastatic squamous cell carcinoma of the head and neck (HNSCC). In 2016, the US Food and Drug Administration (FDA) granted the first immunotherapeutic approvals – the anti-PD-1 immune checkpoint inhibitors nivolumab and pembrolizumab – for the treatment of patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) that is refractory to platinum-based regimens. The European Commission followed in 2017 with approval of nivolumab for treatment of the same patient population, and shortly thereafter with approval of pembrolizumab monotherapy for the treatment of recurrent or metastatic HNSCC in adults whose tumors express PD-L1 with a ≥ 50% tumor proportion score and have progressed on or after platinum-containing chemotherapy. Then in 2019, the FDA granted approval for PD-1 inhibition as first-line treatment for patients with metastatic or unresectable, recurrent HNSCC, approving pembrolizumab in combination with platinum and fluorouracil for all patients with HNSCC and pembrolizumab as a single agent for patients with HNSCC whose tumors express a PD-L1 combined positive score ≥ 1. These approvals marked the first new therapies for these patients since 2006, as well as the first immunotherapeutic approvals in this disease. In light of the introduction of these novel therapies for the treatment of patients with head and neck cancer, The Society for Immunotherapy of Cancer (SITC) formed an expert committee tasked with generating consensus recommendations for emerging immunotherapies, including appropriate patient selection, therapy sequence, response monitoring, adverse event management, and biomarker testing. These consensus guidelines serve as a foundation to assist clinicians’ understanding of the role of immunotherapies in this disease setting, and to standardize utilization across the field for patient benefit. Due to country-specific variances in approvals, availability and regulations regarding the discussed agents, this panel focused solely on FDA-approved drugs for the treatment of patients in the U.S. Electronic supplementary material The online version of this article (10.1186/s40425-019-0662-5) contains supplementary material, which is available to authorized users.

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Section: Key Clinical Questionsmentioning

confidence: 99%

The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC)

Cohen¹,

Bell²,

Bifulco³

et al. 2019

j. immunotherapy cancer

482

422

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show abstract

“…Our patient developed ICI-induced pneumonitis 6 months after initiating immunotherapy and 2 months after withdrawal from it. This is not the most frequent timing, but it is a common experience in clinical practice, and it has been reported in the literature [ 24 , 25 ]. RRP may be triggered by chemotherapy, target therapies, and ICI [ 2 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Radiation Recall Pneumonitis Anticipates Bilateral Immune-Induced Pneumonitis in Non-Small Cell Lung Cancer

Torresan

Zussino

Cortiula

et al. 2023

JCM

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Radiation recall pneumonitis (RRP) is a rare inflammatory reaction that occurs in previously irradiated fields, and it may be caused by various triggering agents. Immunotherapy has been reported to potentially be one of these triggers. However, precise mechanisms and specific treatments have not been explored yet due to a lack of data in this setting. Here, we report a case of a patient who received radiation therapy and immune checkpoint inhibitor therapy for non-small cell lung cancer. He developed first radiation recall pneumonitis and subsequently immune-checkpoint inhibitor-induced pneumonitis (IIP). After presenting the case, we discuss the currently available literature on RRP and the challenges of differential diagnosis between RRP, IIP, and other forms of pneumonitis. We believe that this case is of particular clinical value since it highlights the importance of including RRP in a differential diagnosis of lung consolidation during immunotherapy. Furthermore, it suggests that RRP might anticipate more extensive ICI-induced pneumonitis.

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“…We selected all clinical notes between the date of the first dose of the ICI and the last date of the follow-up or date of start of another ICI. Selecting notes beyond the date of the last dose will allow us to account for delayed irAEs that can happen several weeks or even months after the date of the last dose [26]. 9924 notes were then extracted from the Oncology EHR at MedStar and de-identified using the De-ID software [27] to remove all patient health identifiers.…”

Section: Methodsmentioning

confidence: 99%

Automated Identification of Patients with Immune-related Adverse Events from Clinical Notes using Word embedding and Machine Learning

Gupta

Belouali

Shah

et al. 2020

Preprint

Self Cite

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Immune Checkpoint Inhibitors (ICIs) have substantially improved survival in patients with advanced malignancies. However, ICIs are associated with a unique spectrum of side effects termed Immune-Related Adverse Events (irAEs). To ensure treatment safety, research efforts are needed to comprehensively detect and understand irAEs from real world data (RWD). The goal of this work is to evaluate a Machine Learning-based phenotyping approach that can identify patients with irAEs from a large volume of retrospective clinical notes representing RWD. Evaluation shows promising results with an average F1-score=0.75 and AUC-ROC=0.78. While the extraction of any available irAEs in charts achieves high accuracy, individual irAEs extraction has room for further improvement.

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Delayed toxicities with anti-PD-1 and anti-PDL-1 immune checkpoint inhibitors (ICIs).

Cited by 9 publications

References 0 publications

The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC)

The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC)

Radiation Recall Pneumonitis Anticipates Bilateral Immune-Induced Pneumonitis in Non-Small Cell Lung Cancer

Automated Identification of Patients with Immune-related Adverse Events from Clinical Notes using Word embedding and Machine Learning

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