Infections due to dysregulated immunity: an emerging complication of cancer immunotherapy

Morelli, Tommaso; Fujita, Kohei; Redelman-Sidi, Gil; Elkington, Paul

doi:10.1136/thoraxjnl-2021-217260

Cited by 57 publications

(67 citation statements)

References 132 publications

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“…However, research has found that no significant difference in the use of immunosuppressive agents between patients with and without infections (10,11). Morelli et al suggested that the role of a dysregulated immunity whose mounted response paradoxically favors the pathogen (9). We think that it may be immunotherapy infection due to dysregulated immunity, especially when the patient with psoriasis, which can exacerbate immune disorders.…”

Section: Discussionmentioning

confidence: 88%

“…ICIs theoretically do not seem to directly increase the risk of infection ( 6 ) but rather reactivate the cytotoxic T cells that were suppressed by the cancer cells to attack the tumor cells and enhance the immune system ( 7 , 8 ). It was believed that concomitant use of immunosuppressants including systemic corticosteroids with ICIs treatment increased infection risk ( 9 ). However, research has found that no significant difference in the use of immunosuppressive agents between patients with and without infections ( 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Morelli et al. suggested that the role of a dysregulated immunity whose mounted response paradoxically favors the pathogen ( 9 ). We think that it may be immunotherapy infection due to dysregulated immunity, especially when the patient with psoriasis, which can exacerbate immune disorders.…”

Section: Discussionmentioning

confidence: 99%

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Case report: Mycobacterium neoaurum infection during ICI therapy in a hepatocellular carcinoma patient with psoriasis

Pang

Chen

et al. 2022

Front. Immunol.

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We report here a patient with advanced hepatocellular carcinoma (HCC) and psoriasis treated with immune checkpoint inhibitor (ICI) therapy who experienced tumor partial response and psoriatic exacerbation. Meanwhile, the patient contracted mycobacterium neoaurum during the treatment period, while it was an opportunistic infection and mainly happened in immunosuppressed patients. We discussed the possibility that this infection was an ICI-associated infection independent of immunosuppression due to dysregulated immunity, which was the result of the effects of immunotherapy and autoimmune disease (AID), and the characteristics and treatment of M. neoaurum, which was rarely reported in China. This case highlights the fact that some infections can be precipitated by ICIs in the absence of immunosuppressive treatment, especially the patients with AID.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Case report: Mycobacterium neoaurum infection during ICI therapy in a hepatocellular carcinoma patient with psoriasis

Pang

Chen

et al. 2022

Front. Immunol.

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“…It seems that hyperinflammatory dysregulated immunity associated with ICIs drives pathogenesis. These infections are characterized by a dysregulated inflammatory immune response ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Pneumonia with clinical symptoms precedes imaging evidence after immune checkpoint inhibitors combined with radiotherapy in lung squamous cell cancer

Wang

Wang²,

Yu³

et al. 2022

Front. Immunol.

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Immune-checkpoint inhibitors (ICI) targeting programmed cell death 1 (PD-1) and its ligand 1 (PD-L1) have quickly changed the treatment landscape in advanced non-small cell lung cancer. However, any patient treated with an immune checkpoint inhibitor is at risk for immune-related adverse events (irAEs). Checkpoint inhibitor pneumonitis (CIP) is a rare but potentially severe pulmonary toxicity of immunotherapy. Since the imaging features and symptoms are not specific, the diagnosis of CIP is challenging. In addition, CIP may mimic other lung diseases. Due to these characteristics, proper patient management may be delayed. So, a comprehensive understanding of imaging features is essential for a prompt detection and correct management of these drug-induced lung diseases. We presented a patient with lung squamous cell cancer who has clinical symptoms preceding imaging evidence of pneumonitis after immunotherapy and radiotherapy. We also discussed the safety of immunotherapy, the complexity and management of immune pneumonitis.

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“…Accumulating evidence from biological therapeutics and genomic analyses have suggested that we need to refine our concepts of the spectrum of human disease [ 5 , 6 ]. Importantly, this includes confirmation in patients that an excessive immune response can be just as harmful as an insufficient response, as illustrated by increased TB incidence with PD-1 inhibition in cancer immunotherapy [ 6. , 7.…”

Section: Human Tb: the Intricate And Prolonged Contest Between Host And Pathogenmentioning

confidence: 99%

Understanding the tuberculosis granuloma: the matrix revolutions

Elkington

Polak

Reichmann

et al. 2022

Trends in Molecular Medicine

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Mycobacterium tuberculosis ( Mtb) causes the human disease tuberculosis (TB) and remains the top global infectious pandemic after coronavirus disease 2019 (COVID-19). Furthermore, TB has killed many more humans than any other pathogen, after prolonged coevolution to optimise its pathogenic strategies. Full understanding of fundamental disease processes in humans is necessary to successfully combat this highly successful pathogen. While the importance of immunodeficiency has been long recognised, biologic therapies and unbiased approaches are providing unprecedented insights into the intricacy of the host–pathogen interaction. The nature of a protective response is more complex than previously hypothesised. Here, we integrate recent evidence from human studies and unbiased approaches to consider how Mtb causes human TB and highlight the recurring theme of extracellular matrix (ECM) turnover.

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Infections due to dysregulated immunity: an emerging complication of cancer immunotherapy

Cited by 57 publications

References 132 publications

Case report: Mycobacterium neoaurum infection during ICI therapy in a hepatocellular carcinoma patient with psoriasis

Case report: Mycobacterium neoaurum infection during ICI therapy in a hepatocellular carcinoma patient with psoriasis

Case report: Pneumonia with clinical symptoms precedes imaging evidence after immune checkpoint inhibitors combined with radiotherapy in lung squamous cell cancer

Understanding the tuberculosis granuloma: the matrix revolutions

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