Emerging concerns of infectious diseases in lung cancer patients receiving immune checkpoint inhibitor therapy

Fujita, Kohei; Kim, Young Hak; Kanai, Osamu; Yoshida, Hironori; Mio, Tadashi; Hirai, Toyohiro

doi:10.1016/j.rmed.2018.11.021

Cited by 91 publications

(101 citation statements)

References 14 publications

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“…Another study of 167 NSCLC patients treated with nivolumab reported that 33 infections occurred in total, of which 25 were bacterial, two were fungal and six were viral. Diabetes mellitus was an independent risk factor for infection …”

Section: Clinical Data Review and Description Of Potential Mechanism mentioning

confidence: 99%

“… Pneumonia is the most common infection in patients with irAEs . For patients with signs of infection, initiation of empirical antimicrobial treatment as soon as possible is advised, while further microbiological examinations are needed to identify pathogens.…”

Section: Treatmentsmentioning

confidence: 99%

“…For patients with signs of infection, initiation of empirical antimicrobial treatment as soon as possible is advised, while further microbiological examinations are needed to identify pathogens. Compound sulfamethoxazole is recommended for PCP treatment, while alternative regimens may be used for patients with sulfa allergy. Studies have shown that diabetes is an important risk factor for PD‐1/PD‐L1 inhibitor‐related infections . Thus, tight glycemic control is recommended during treatment. Precautionary measures: For patients with irAEs who are expected to receive prednisone (≥ 20 mg/day) or other equivalent glucocorticoids for at least four weeks, anti‐pneumocystis prophylaxis is recommended …”

Section: Treatmentsmentioning

confidence: 99%

“…Diabetes mellitus was an independent risk factor for infection. 2 Of note, among patients without irAEs or additional immunosuppressive therapy, there exists a potential risk of reactivation of chronic/latent infections. Seven cases have been recently reported that describe reactivation of latent tuberculosis infection (LTBI), most occurring within three months after treatment with PD-1/PD-L1 inhibitors.…”

Section: Clinical Data Review and Description Of Potential Mechanism mentioning

confidence: 99%

“…It is currently believed that PD‐1/PD‐L1 inhibitors do not increase the risk of infection because they promote T‐cell effector functions. However, immune‐related adverse events (irAEs) induced by PD‐1/PD‐L1 inhibitors may require treatment with immunosuppressive agents, which could cause opportunistic infections . In addition, there have been several reports describing reactivation of latent/chronic infections during immunotherapy without irAEs or having received immunosuppressants …”

Section: Introductionmentioning

confidence: 99%

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Recommendation for the diagnosis and management of immune checkpoint inhibitor related infections

Wang

et al. 2020

Thoracic Cancer

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Immune checkpoint inhibitors (ICIs) have been widely used in the management of malignant tumors. Programmed death 1 (PD‐1)/PD‐1 ligand (PD‐L1) inhibitors have been introduced to treat non‐small cell lung cancer (NSCLC) in recent years. Currently, PD‐1/PD‐L1 inhibitors are considered to have minor side effects and do not independently increase the risk of infection. However, they may cause immune‐related adverse events (irAEs) that require immunosuppressive therapy with corticosteroids and/or immunosuppressants, leading to opportunistic infections. Furthermore, there have been reports describing reactivation of chronic/latent infections without irAEs or having received immunosuppressants. Thus, immune checkpoint inhibitor related infections have received more attention worldwide. In this paper, we review available clinical data, describe the potential mechanism, and propose recommendations for the diagnosis and clinical management of PD‐1/PD‐L1 inhibitor‐related infections.

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Section: Clinical Data Review and Description Of Potential Mechanism mentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

Section: Clinical Data Review and Description Of Potential Mechanism mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recommendation for the diagnosis and management of immune checkpoint inhibitor related infections

Wang

et al. 2020

Thoracic Cancer

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Respiratory Complications

Shannon¹,

Eapen²,

Jiménez³

et al. 2022

Holland‐Frei Cancer Medicine

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Overview The respiratory system is particularly susceptible to complications of cancer and cancer therapy. This vulnerability arises from the stringent architectural requirements for gas exchange, the continuous exposure of the respiratory tract to the external environment, and the severe symptoms that can accompany respiratory compromise. Gas exchange requires patent airways, an effective musculoskeletal ventilatory pump, a thin alveolocapillary membrane, and adequate blood flow through the pulmonary circulation. In cancer patients, primary and metastatic tumors of the chest compromise major airways; pleural effusions externally compress the lungs and impair diaphragmatic function; direct, hematogenous or lymphangitic spread of tumor replaces functioning lung parenchyma; resectional surgery reduces parenchymal volume; nonresectional surgery can transiently impair lung function; radiotherapy, chemotherapy, stem cell therapy, and infection injure the vulnerable alveolocapillary membrane; tumors directly or indirectly compromise the musculoskeletal pump; venous thromboembolism and pulmonary vasculopathy obstruct pulmonary blood flow. The normal respiratory system contains considerable physiologic reserve, such that surgical loss of one lung is generally well tolerated. However, in cancer patients, insults to multiple components of the respiratory system may result in progressive loss of physiologic reserve and increasing dyspnea. Dyspnea, cough, wheezing, stridor, chest pain, and hemoptysis are common symptoms in the cancer setting that lead to pulmonary consultation. In this article, we will discuss the pathophysiology, diagnosis, and management of the major respiratory complications of cancer and its therapy. We begin with the direct effects of cancer and cancer therapies on the lungs, review major indirect effects of cancer on the lungs, and end with respiratory failure in the cancer patient.

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Characteristics and risk factors for microbial infections during cancer immune checkpoint therapy

Kanjanapan

Yip

2020

Cancer Medicine

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The risk of infection in patients receiving immune checkpoint inhibitor (ICI) therapy is not well understood. Immune‐related adverse events requiring immunosuppressive therapy may impact infection risk. ICIs may induce an exaggerated immune response to latent infection. We assessed the incidence and risk factors for infections during cancer ICI therapy. A retrospective chart review of solid tumor patients treated with ICIs was conducted. Infectious episodes were defined as those where a microbial organism was cultured or identified through polymerase chain reaction. Infections which occurred during and up to 1 year following ICI therapy were considered “post‐ICI” infections. Of 327 patients, 47% had melanoma and 36% had non‐small cell lung cancer. The majority (77%) received single agent anti‐PD(L)1 antibody, 14% received combination anti‐PD(L)1 and anti‐CTLA4 antibody, and 9% single agent anti‐CTLA4 antibody. Infections occurred in 89 (27%) in the post‐ICI compared with 111 (34%) patients in the pre‐ICI period ( p = 0.57). The most common types of infection were respiratory, genitourinary, and cutaneous infections. On multivariate analysis, only age over 67 years significantly predicted for development of infection on ICI (HR 1.73, p = 0.04). We did not find receipt of corticosteroids, combination ICI therapy, diabetes, or gender to significantly impact on infection risk. The rate of microbial infections among solid tumor patients receiving ICI therapy was 27%, comparable to the infection rate of 34% in the same cohort of patients in the period pre‐ICI therapy. Age over 67 years was significantly associated with infection post‐ICI.

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Emerging concerns of infectious diseases in lung cancer patients receiving immune checkpoint inhibitor therapy

Cited by 91 publications

References 14 publications

Recommendation for the diagnosis and management of immune checkpoint inhibitor related infections

Recommendation for the diagnosis and management of immune checkpoint inhibitor related infections

Respiratory Complications

Characteristics and risk factors for microbial infections during cancer immune checkpoint therapy

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