Immune-Related Adverse Events: Pneumonitis

Zhong, Linda; Altan, Mehmet; Shannon, Vickie R.; Sheshadri, Ajay

doi:10.1007/978-3-030-41008-7_13

Cited by 42 publications

(25 citation statements)

References 137 publications

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“…Immune checkpoint inhibitors reactivate T cells to kill cancer cells but also destroy immune homeostasis, which has serious adverse impacts, including autoimmunity and nonspecific inflammation, on almost all bodily organs. It is estimated that irAEs occur predominantly in melanoma, lung, kidney, and other cancers (109,110). Regarding IRLI, few studies and experiments have explored the related signaling pathways, and knowledge of this phenomenon is relatively superficial, although many case reports have referred to this complication caused by immune checkpoint inhibitors (111)(112)(113).…”

Section: Signaling Pathways Of Irli and Treatment Thereofmentioning

confidence: 99%

Crossed Pathways for Radiation-Induced and Immunotherapy-Related Lung Injury

et al. 2021

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Radiation-induced lung injury (RILI) is a form of radiation damage to normal lung tissue caused by radiotherapy (RT) for thoracic cancers, which is most commonly comprised of radiation pneumonitis (RP) and radiation pulmonary fibrosis (RPF). Moreover, with the widespread utilization of immunotherapies such as immune checkpoint inhibitors as first- and second-line treatments for various cancers, the incidence of immunotherapy-related lung injury (IRLI), a severe immune-related adverse event (irAE), has rapidly increased. To date, we know relatively little about the underlying mechanisms and signaling pathways of these complications. A better understanding of the signaling pathways may facilitate the prevention of lung injury and exploration of potential therapeutic targets. Therefore, this review provides an overview of the signaling pathways of RILI and IRLI and focuses on their crosstalk in diverse signaling pathways as well as on possible mechanisms of adverse events resulting from combined radiotherapy and immunotherapy. Furthermore, this review proposes potential therapeutic targets and avenues of further research based on signaling pathways. Many new studies on pyroptosis have renewed appreciation for the value and importance of pyroptosis in lung injury. Therefore, the authors posit that pyroptosis may be the common downstream pathway of RILI and IRLI; discussion is also conducted regarding further perspectives on pyroptosis as a crucial signaling pathway in lung injury treatment.

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Section: Signaling Pathways Of Irli and Treatment Thereofmentioning

confidence: 99%

Crossed Pathways for Radiation-Induced and Immunotherapy-Related Lung Injury

et al. 2021

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“…Chest CT of patients with OP usually appears as ground-glass opacities or consolidations mainly observed in the lung periphery. Characteristic pathological finding is the abnormal proliferation of granulation tissue in distal airspaces [18]. In the literature there are several studies that describe organizing pneumonia as a type of lung toxicity due to cancer immunotherapy [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Section: Interstitial Lung Diseasementioning

confidence: 99%

Pulmonary adverse events due to immune checkpoint inhibitors: A literature review

Georgakopoulou

Garmpis

Mermigkis

et al. 2021

Monaldi Arch Chest Dis

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Cancer immunotherapy aims to stimulate the immune system to fight against tumors, utilizing the presentation of molecules on the surface of the malignant cells that can be recognized by the antibodies of the immune system. Immune checkpoint inhibitors, a type of cancer immunotherapy, are broadly used in different types of cancer, improving patients’ survival and quality of life. However, treatment with these agents causes immune-related toxicities affecting many organs. The most frequent pulmonary adverse event is pneumonitis representing a non-infective inflammation localized to the interstitium and alveoli. Other lung toxicities include airway disease, pulmonary vasculitis, sarcoid-like reactions, infections, pleural effusions, pulmonary nodules, diaphragm myositis and allergic bronchopulmonary aspergillosis. This review aims to summarize these pulmonary adverse events, underlining the significance of an optimal expeditious diagnosis and management.

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“…In ICI pneumonitis, bronchoscopy is mainly used to exclude infectious pneumonia. Using bronchoscopy, a deep sputum sample can be collected, which is reliable for elimination of the differential diagnosis of infection and guidance of antimicrobial therapy (21). In ICI pneumonitis, BAL fluid often show lymphocytic inflammation of alveoli with an increased proportion of lymphocytes in the cell count [normal lymphocyte count ≈11%, in ICI pneumonitis ≈37% (22,23)].…”

Section: Bronchoscopymentioning

confidence: 99%

“…As in radiologic assessment, four accompanying key patterns of ICI pneumonitis can be recognized on pathologic examination; OP, NSIP, HP, and diffuse alveolar damage (DAD) (21).…”

Section: Pathologymentioning

confidence: 99%

Differentiation of COVID-19 Pneumonitis and ICI Induced Pneumonitis

et al. 2020

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Immune checkpoint inhibitors (ICI) have become the standard of care treatment for several tumor types. ICI-induced pneumonitis is a serious complication seen with treatment with these agents. Cancer has been reported to be one of the risk factors for severe coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that has engulfed the world in the last couple of months. In patients with cancer treated with ICI who present at the emergency department with respiratory symptoms during the COVID-19 pandemic, correct diagnosis can be challenging. Symptoms and radiological features of ICI pneumonitis can be overlapping with those of COVID-19 related pneumonia. For the latter, dexamethasone and remdesivir have shown encouraging results, while vaccines are currently being evaluated in phase III trials. The mainstay of treatment in ICI pneumonitis is immunosuppressive therapy, as this is a potentially fatal adverse event. It has been speculated that immunosuppression may be associated with increased risk of progression to severe COVID-19, especially during the early stage of infection with SARS-CoV-2. Therefore, distinction between these two entities is warranted. We summarize the clinical, radiological features as well as additional investigations of both entities, and suggest a diagnostic algorithm for distinction between the two. This algorithm may be a supportive tool for clinicians to diagnose the underlying cause of the pneumonitis in patients treated with ICI during this COVID-19 pandemic.

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Immune-Related Adverse Events: Pneumonitis

Cited by 42 publications

References 137 publications

Crossed Pathways for Radiation-Induced and Immunotherapy-Related Lung Injury

Crossed Pathways for Radiation-Induced and Immunotherapy-Related Lung Injury

Pulmonary adverse events due to immune checkpoint inhibitors: A literature review

Differentiation of COVID-19 Pneumonitis and ICI Induced Pneumonitis

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