Diagnosis and management of pulmonary toxicity associated with cancer immunotherapy

Rashdan, Sawsan; Minna, John D.; Gerber, David E.

doi:10.1016/s2213-2600(18)30172-3

Cited by 67 publications

(88 citation statements)

References 55 publications

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“…31 Of note, in patients with cancer receiving immunotherapy (mostly with program med death 1 and programmed death ligand 1 inhibitors), the incidence of pneumonitis can reach 4%. 32,39 Acute respiratory failure occurs in about 5% of kidney transplant recipients and 12-14% of heart or lung transplant recipients. 34,36 Overall, mortality among patients with acute respiratory failure is about 50%, depending on the underlying condition, nature, severity, and course of the respiratory failure, need for IMV, and associated organ dysfunctions.…”

Section: Epidemiologymentioning

confidence: 99%

Acute respiratory failure in immunocompromised adults

Azoulay

Mokart

Kouatchet

et al. 2019

The Lancet Respiratory Medicine

110

100

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Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undeter mined cause, a standardised diagnostic investi gation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.www.thelancet.com/respiratory Vol

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Section: Epidemiologymentioning

confidence: 99%

Acute respiratory failure in immunocompromised adults

Azoulay

Mokart

Kouatchet

et al. 2019

The Lancet Respiratory Medicine

110

100

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“…Moreover in terms of lung toxicity early diagnosis represents a great challenge for oncologists and radiologists and it also resembles other types of interstitial pneumonia [107]. In fact the spectrum of pulmonary manifestations of toxicity of immunotherapy is wide; therefore, it required differential diagnoses of infectious disease and neoplastic tumors [108]. The main radiological patterns for lung toxicities include organizing pneumonitis, nonspecific interstitial pneumonitis, hypersensitivity pneumonitis, ground-glass opacities or sarcoid-like granulomas [31].…”

Section: Discussionmentioning

confidence: 99%

An update on the safety of nivolumab for the treatment of advanced melanoma

Czarnecka

Rutkowski

2020

Expert Opinion on Drug Safety

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Introduction: Due to its unique mechanism of action as an immune checkpoint inhibitor, nivolumab has high antitumor activity, but at the same time this mechanism is responsible for immune-related adverse events that may limit patients' safety and therapy continuation. Areas covered: Long-term safety of nivolumab including 5-year follow-up, safety of nivolumab treatment after ipilimumab therapy, safety of nivolumab in challenging subgroups (elderly, patients with brain metastases, patients with autoimmune disorders), safety of nivolumab in with rare melanoma subtypes (including mucosal melanoma), as well as specificity of AEs reported for nivolumab treatment in melanoma patients in comparison to other cancer types and other immunotherapy molecules, and impact of AEs on response rates and PFS on nivolumab treatment are discussed. Expert opinion: Search for biomarkers that would help us to identify patient populations that may suffer from severe nivolumab toxicity could help in selecting patients that should not be treated with this type of therapy. Novel combinations and immunotherapy drugs including use of NKTR-214 (IL-2 pathway), lymphocyte-activation gene 3 (LAG-3), local injections of talimogene laherparepvec (T-VEC), or systemic use of T-cell receptors agonists such as OX40, CD137, ICOS-1, could provide regimens with limited toxicity and higher activity.

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“…If the clinical symptoms and oxygen saturation are stable, chest CT can be repeated at least every 3-4 weeks. [41][42]46 If not, chest CT should be arranged for If it has not improved, another immunosuppressant or anti-TNF-should be added. 41,46 IV immunoglobulin (IVIG) might be an add-on rescue choice.…”

Section: Managementmentioning

confidence: 99%

“…The same type of ICI should not be reinitiated. 42,46 Opportunistic infections should be monitored during treatment with corticosteroids and other immunosuppressants. During the administration of corticosteroids, calcium and vitamin D supplementation are recommended.…”

Section: Managementmentioning

confidence: 99%

Programmed cell death 1 (PD‐1)/PD‐ligand 1(PD‐L1) inhibitors‐related pneumonitis in patients with advanced non–small cell lung cancer

Sun

Shao

et al. 2020

Asia-Pac J Clncl Oncology

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Immune-related pneumonitis is an uncommon but potentially fatal immune-related adverse event in advanced non-small cell lung cancer (NSCLC) patients during treatment with anti-programmed cell death 1 (PD-1) and programmed cell death-ligand 1 (PD-L1). Underlying emphysema, interstitial lung disease (ILD), and previous radiation therapy for lung cancer might be factors precipitating immune-related pneumonitis. The incidence of immune-related pneumonitis is reported to be higher in those treated with PD-1 inhibitors than in those treated with anti-PD-L1 inhibitors. Early detection and diagnosis and appropriate management according to the severity are critical to improving the prognosis. The first-line physicians, including the primary responsible oncologists, family doctors, emergency physicians and NSCLC patients should be trained to identify and report symptoms of immune-related pneumonitis as early as possible. Multidisciplinary treatment teams involving clinicians (including ILD specialists and lung cancer specialists), radiologists and pathologists are recommended for the treatment of immune-related pneumonitis.

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Diagnosis and management of pulmonary toxicity associated with cancer immunotherapy

Cited by 67 publications

References 55 publications

Acute respiratory failure in immunocompromised adults

Acute respiratory failure in immunocompromised adults

An update on the safety of nivolumab for the treatment of advanced melanoma

Programmed cell death 1 (PD‐1)/PD‐ligand 1(PD‐L1) inhibitors‐related pneumonitis in patients with advanced non–small cell lung cancer

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