Knowledge Gaps and Research Priorities in Immune Checkpoint Inhibitor–related Pneumonitis. An Official American Thoracic Society Research Statement

Abstract

Rationale: Immune checkpoint inhibitors (ICIs) have revolutionized cancer care but are associated with unique adverse events, including potentially life-threatening pneumonitis. The diagnosis of ICI-pneumonitis is increasing; however, the biological mechanisms, clinical and radiologic features, and the diagnosis and management have not been well defined. Objectives: To summarize evidence, identify knowledge and research gaps, and prioritize topics and propose methods for future research on ICI-pneumonitis. Methods: A multidisciplinary group of international clinical researchers reviewed available data on ICI-pneumonitis to develop and refine research questions pertaining to ICI-pneumonitis. Results: This statement identifies gaps in knowledge and develops potential research questions to further expand knowledge regarding risk, biologic mechanisms, clinical and radiologic presentation, and management of ICI-pneumonitis. Conclusions: Gaps in knowledge of the basic biological mechanisms of ICI-pneumonitis, coupled with a precipitous increase in the use of ICIs alone or combined with other therapies, highlight the importance in triaging research priorities for ICI-pneumonitis.

Pneumonitis Induced by Immune Checkpoint Inhibitors: From Clinical Data to Translational Investigation

“…The degrees of irAEs are mostly from mild to moderate, but there are also serious adverse reactions that endanger patients' lives, such as immune-related pneumonitis, nephritis, and myocarditis. Pneumonitis induced by ICIs is now referred to as checkpoint inhibitor pneumonitis (CIP) (4). Although CIP is rare, it has a poor prognosis, accounting for 28% of fatal events (5).…”

Immune-related adverse events: a retrospective look into the future of oncology in the intensive care unit

“…Termed immune related adverse events (irAEs), the side effects of these novel therapeutic antibodies result from the loss of immune homeostasis and off-target effects in peripheral tissues [2,3]. Although the skin, endocrine glands and digestive tract are mostly affected, pulmonary [4][5][6], neurologic [7][8][9][10], hepatic [11][12][13] and cardiologic [14][15][16][17][18][19] side effects have also been described and may be life-threatening.…”

Clinical management of lung cancer patients during the outbreak of COVID-19 epidemic

“…The clinical symptoms of the immune checkpoint inhibitor-associated pneumonia including fever, increased cough and sputum, and increased dyspnea. Chest CT shows ground glass and flake shadows in the lungs, and some patients can simply show ground glass shadows in the lungs [ 49 ]. This also requires multidisciplinary cooperation including oncology, imaging, and infectious diseases, comprehensive analysis and identification, and guidance for subsequent treatment.…”