Findings on Chest CT Performed in the Emergency Department in Patients Receiving Immune Checkpoint Inhibitor Therapy: Single-Institution 8-Year Experience in 136 Patients

Smith, Daniel A.; Radzinsky, Ethan; Tirumani, Sree H.; Güler, Ezgi; Petraszko, Andrew; Kikano, Elias; Hoimes, Christopher J.; Ramaiya, Nikhil H.

doi:10.2214/ajr.20.24758

Cited by 9 publications

(3 citation statements)

References 22 publications

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“…When comparing patients with suspected RRP after ICI and patients with no relation to prior radiation therapy, we found no difference in management, nor any significant difference in duration of the steroid treatment. In one study of 136 patients being suspected of ir-pneumonitis, 29% of cases were classified as RRP [ 18 ], which is similar to our finding. In future studies on ir-pneumonitis, it is relevant to include data on RRP and to explore if re-introducing ICI might be safe for this patient group.…”

Section: Discussionsupporting

confidence: 89%

A retrospective study on immune-related pneumonitis in patients with non-small-cell lung cancer undergoing treatment with PD-1/PD-L1 inhibitors

Yakymenko

Skougaard

2023

European Clinical Respiratory Journal

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Background Lung cancer patients undergoing treatment with immune checkpoint inhibitors (ICIs) are at risk of developing immune-related (ir-)pneumonitis. Since lung cancer patients have competing reasons for respiratory symptoms, this poses a diagnostic challenge. This study aimed to explore diagnosis and management of ir-pneumonitis in this patient group. Materials and Methods Suspected ir-pneumonitis was frequent in this group of patients. The cohort was characterized by high heterogeneity and lack of unequivocal diagnostic conclusions. Treatment of ir-pneumonitis was longer than recommended and involvement of pulmonologist was very infrequent. The result of this study reflects the difficulties in a daily clinical setting to diagnose and manage patients with lung cancer presenting with pulmonary symptoms. Results Suspected ir-pneumonitis was frequent in this group of patients. The cohort was characterized by high heterogeneity and lack of unequivocal diagnostic conclusions. Treatment of ir-pneumonitis was longer than recommended and involvement of pulmonologist was very infrequent. The result of this study reflects the difficulties in a daily clinical setting to diagnose and manage patients with lung cancer presenting with pulmonary symptoms.

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Section: Discussionsupporting

confidence: 89%

A retrospective study on immune-related pneumonitis in patients with non-small-cell lung cancer undergoing treatment with PD-1/PD-L1 inhibitors

Yakymenko

Skougaard

2023

European Clinical Respiratory Journal

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“…Pulmonary adverse events in lung cancer patients may also involve the pleura, leading in some cases to pleural effusions that may be misdiagnosed as disease relapse [ 44 ▪▪ ]. Radiological patterns of lung disease include hypersensitivity pneumonitis, acute interstitial pneumonitis, organizing pneumonia, nonspecific interstitial pneumonia, traction bronchiectasis, radiation recall pneumonitis (e.g., delayed inflammatory reaction in a previously irradiated lung parenchyma), bronchiolitis and, rarely, acute fibrinous organizing pneumonia and lipoid pneumonia [ 45 , 46 ]. Pembrolizumab monotherapy has been associated more frequently with acute pulmonary events, including ICI-related pneumonitis and pulmonary embolism requiring hospitalization, compared to other ICIs [ 45 ].…”

Section: Pembrolizumabmentioning

confidence: 99%

“…Pembrolizumab monotherapy has been associated more frequently with acute pulmonary events, including ICI-related pneumonitis and pulmonary embolism requiring hospitalization, compared to other ICIs [ 45 ]. Of note, only 12.9% of these events were solely pneumonitis [ 45 ]. In addition, concomitant administration of pembrolizumab with other ICIs is strongly associated with thromboembolic events in melanoma and metastatic gastric cancer patients [ 47 ].…”

Section: Pembrolizumabmentioning

confidence: 99%

Pulmonary adverse events following immune checkpoint inhibitors

Spagnolo

Chaudhuri

Bernardinello

et al. 2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewImmune checkpoint inhibitors (ICIs) have rapidly become a mainstay of cancer treatment. However, immune modulation resulting from checkpoint inhibition can cause inflammation in any organ system, with pneumonitis being one of the most severe immune-related adverse events (irAEs). Here, we review the most recent literature on pulmonary adverse events following ICIs.Recent findingsSeveral systematic reviews and meta-analyses of data from trials of antiprogrammed death-1 (PD-1; nivolumab, pembrolizumab), anti-PD-ligand-1 (PD-L1; atezolizumab, avelumab, durvalumab) and anticytotoxic T lymphocyte antigen-4 (CTLA-4; ipilimumab or tremelimumab) in patients with advanced cancer have explored the relative risk and incidence of lung toxicity among different tumor types and therapeutic regimens. They have showed that the incidence of all-grade (1–4) and high-grade (3–4) pneumonitis is significantly higher in nonsmall cell lung cancer (NSCLC) compared with other tumor types. In addition, they have demonstrated that immunotherapy, especially monoimmunotherapy, has a significantly lower risk of irAEs compared to immune-chemotherapy. Treatment for lung cancer, preexisting interstitial lung disease, smoking history and male sex appear to increase the risk for ICI-related pneumonitis.SummaryLung toxicity is an uncommon but potentially severe and even fatal complication of ICIs. Timely recognition is critically important but challenging, particularly in patients with lung cancer wherein drug toxicity can mimic disease progression or recurrence.

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Emergency department imaging utilization of cancer patients treated with bevacizumab: single-institution 8-year experience

et al. 2023

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Findings on Chest CT Performed in the Emergency Department in Patients Receiving Immune Checkpoint Inhibitor Therapy: Single-Institution 8-Year Experience in 136 Patients

Cited by 9 publications

References 22 publications

A retrospective study on immune-related pneumonitis in patients with non-small-cell lung cancer undergoing treatment with PD-1/PD-L1 inhibitors

A retrospective study on immune-related pneumonitis in patients with non-small-cell lung cancer undergoing treatment with PD-1/PD-L1 inhibitors

Pulmonary adverse events following immune checkpoint inhibitors

Emergency department imaging utilization of cancer patients treated with bevacizumab: single-institution 8-year experience

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