Infliximab in the treatment of tislelizumab-induced steroid-refractory immune checkpoint inhibitor-related pneumonia: case report and literature review

Abstract

Background: Infliximab has been recommended by the American Society of Clinical Oncology (ASCO) guidelines for the treatment of steroid-refractory immune checkpoint inhibitor-related pneumonia (CIP), but clinical evidence remains insufficient. In order to improve the level of diagnosis and treatment and rational use of infliximab in the treatment of CIP, a successful case is reported and the relevant literature is reviewed.Case Description: We report a 67-year-old male patient with small cell lung cancer (SCLC) who was admitted to hospital with rapidly worsening dyspnea and bilateral interstitial lung following PD-1 inhibitor (tislelizumab) combined with chemotherapy and radiation therapy. According to the comprehensive judgment of the patient's medical history, clinical symptoms, imaging manifestations, laboratory tests, exclusion of infection, heart failure and treatment response, the diagnosis of grade 4 CIP was made. The patient's condition did not improve after high-dose glucocorticoid and immunoglobulin therapy. After infliximab was added, the clinical manifestations and imaging were significantly improved, oxygenation index also gradually return to normal, then the patient was discharged smoothly.Conclusions: This report suggests that infliximab should be considered when high-dose glucocorticoids combined with immunoglobulin are ineffective for severe CIP. At the same time, this case indicates that inflammatory factors, especially tumor necrosis factor (TNF-α), may be prospective in predicting the efficacy of infliximab in the treatment of steroid-refractory CIP.

Uncommon Adverse Events of Immune Checkpoint Inhibitors in Small Cell Lung Cancer: A Systematic Review of Case Reports

“…This represents the first documented case of refractory immune-related thrombocytopenia and anemia occurring simultaneously, notable for its occurrence in SCLC, while previous cases were observed in patients with NSCLC and melanoma [53,54]. Chen et al reported an unusual increase in hepatitis B surface antibody (HBs Ab) in a 62-year-old patient with brain metastasis who was previously HBsAg-negative [32]. This patient was asymptomatic, and it was the first report of a continuous rise in HBs Ab levels following PD-L1 therapy.…”

Anti‑PD‑1/PD‑L1 and anti‑CTLA‑4 associated checkpoint inhibitor pneumonitis in non‑small cell lung cancer: Occurrence, pathogenesis and risk factors (Review)

“…Elevated IL-1β at baseline and early in anti-PD-1 therapy (1-6 weeks after anti-PD-1 therapy) is predictive of irAEs ( 70 ). A case report demonstrated that the levels of IL-1β were significantly elevated in the serum of CIP patients (21.9 pg/ml) ( 82 ). Suresh et al ( 50 ) observed that the number of monocytes expressing IL-1β in the BALF increased noticeably, while soluble IL-1β levels decreased during the development of CIP.…”