Immune Checkpoint Inhibitor Therapy–related Pneumonitis: Patterns and Management

Abstract

Abbreviations: AIP = acute interstitial pneumonia, ARDS = acute respiratory distress syndrome, CTCAE = Common Terminology Criteria for Adverse Events, CTLA-4 = cytotoxic T-lymphocyte antigen-4, HP = hypersensitivity pneumonitis, ICI = immune checkpoint inhibitor, irAE = immune-related adverse event, NSIP = nonspecific interstitial pneumonia, OP = organizing pneumonia, PD-1 = programmed cell death protein 1, PD-L1 = programmed cell death ligand 1

Clinical and Radiographic Presentations of COVID-19 Among Patients Receiving Radiation Therapy for Thoracic Malignancies

“…Additionally, patients who have a history of systemic therapy, particularly immunotherapy, may also have pulmonary parenchymal changes over time. 24 However, as shown in the cases presented here, the rapidity of infiltrate appearance on treatment should prompt immediate attention by the treating physician for symptom screening, vital signs, and appropriate triage to institutional COVID testing. Conversely, negative CBCTs should not be used to clinically "clear" patients who are having other COVID-associated symptoms, such as fever, new or worsening cough, new or worsening shortness of breath, or pleuritis.…”

Controversies About COVID-19 and Anticancer Treatment with Immune Checkpoint Inhibitors

“…The overall incidence rate of ICI-related pneumonitis ranges from 2.5-5% with anti-PD-1/PD-L1 monotherapy to 7-10% with anti-CTLA-4/anti-PD-1 combination therapy [12]. The dominant radiological pattern of lung immune-related adverse events (irAEs) is organizing pneumonia, but ICI-related pneumonitis could exhibit a variety of patterns, also including nonspecific interstitial pneumonitis [13]. Despite being rarer than other irAEs, pneumonitis is the most fatal AE associated with PD-1/PD-L1 inhibitor therapy, accounting for 35% of treatment-related toxic deaths [14].…”

Immune Checkpoint Inhibitor-Related Pneumonitis

“…4). Regarding prior RT, as it has been described with conventional chemotherapy, ICI could act as an inciting agent, which induces inflammation in the previously irradiated area (recall pneumonitis) [81].…”