Nivolumab-induced organizing pneumonitis in a patient with lung sarcomatoid carcinoma

Gounant, V.; Brosseau, Solenn; Naltet, Charles; Opsomer, Marie-Agnès; Antoine, Martine; Danel, Claire; Khalil, Antoine; Cadranel, Jacques; Zalcman, Gérard

doi:10.1016/j.lungcan.2016.07.010

Cited by 38 publications

(25 citation statements)

References 15 publications

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“…Bronchoalveolar lavage and histology in ICI-P Only a few studies have reported the results of bronchoalveolar lavage (BAL) or pulmonary biopsies. The BAL studies found lymphocyte alveolitis in six case reports [61,62,[64][65][66][67]71], with a lymphocyte proportion between 32.5% and 82% and no pathogens found. In four cases, transbronchial lung biopsies (TBLB) were performed [61,64,65,67], with organising pneumonia lesions detected in three cases and nonspecific lesions in the last case.…”

Section: Clinical Characteristics Computed Tomography Scan Findings mentioning

confidence: 94%

“…The authors did not employ the same terminology for the abnormality patterns, and it is thus difficult to draw comparison between the published series. Of note, organising pneumonia (figure 2b) has been the most frequent pattern observed in 19-100% of patients from the published series [76,77,79,80] and in 62.5% of the case reports [61][62][63][64][65][66][67][68][69][70][71][72].…”

Section: Clinical Characteristics Computed Tomography Scan Findings mentioning

confidence: 95%

“…Since 2015, >200 cases of ICI-P have been reported as isolated cases [61][62][63][64][65][66][67][68][69][70][71][72][73][74] or retrospective series involving between eight and 64 patients [75][76][77][78][79][80] (tables 2 and 3). Three series only included NSCLC patients [77][78][79], while the others involved different cancer types and, in particular, melanomas (20-95%) [75,76,80].…”

Section: Ici-related Pneumonitis In Series and Case Reportsmentioning

confidence: 99%

“…A CT scan was performed in the majority of ICI-P cases, with homogenous elementary radiological lesions detected in the 180 thoracic CT scans retrieved in the literature, 160 of which were described in the published series [75][76][77][78][79][80] and 20 in isolated case reports [61][62][63][64][65][66][67][68][69][70][71][72][73][74] (table 4). These were mainly ground-glass opacities (n=120, 66.7%) (figure 2a), consolidations (n=102, 56.6%) (figure 2b), reticular opacities (interlobular lines, interlobular septal thickenings) (n=47, 26.1%), bronchiectasis (n=19, 10.5%) and micronodules (n=7, 4%).…”

Section: Clinical Characteristics Computed Tomography Scan Findings mentioning

confidence: 99%

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Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

et al. 2019

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Immune checkpoint inhibitor-related pneumonitis (ICI-P) during cancer treatment is rarely observed (<5%). ICI-P is more often observed in patients with nonsmall cell lung cancer (NSCLC) than in those with other cancers. Likewise, it is more common in those receiving programmed cell death (PD)-1/PD-1 ligand inhibitors rather than cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors alone. The frequency of ICI-P is higher when anti-PD-1 and anti-CTLA-4 are administered concomitantly. Despite the low fatality rate (≈13%), ICI-P is the leading cause of ICI-related deaths. This narrative review focuses on the epidemiology, clinical and radiological presentation and prognosis of ICI-P occurring in patients, especially those with advanced NSCLC. Emphasis is placed on the differences in terms of frequency or clinical picture observed depending on whether the ICI is used as monotherapy or in combination with another ICI or chemotherapy. Other pulmonary complications observed in cancer patients, yet not necessarily immune-related, are reviewed, such as sarcoid-like granulomatosis, tuberculosis or other infections. A proposal for pragmatic management, including differential diagnosis and therapeutic strategies, is presented, based on the ICI-P series reported in the literature and published guidelines.

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Section: Clinical Characteristics Computed Tomography Scan Findings mentioning

confidence: 94%

Section: Clinical Characteristics Computed Tomography Scan Findings mentioning

confidence: 95%

Section: Ici-related Pneumonitis In Series and Case Reportsmentioning

confidence: 99%

Section: Clinical Characteristics Computed Tomography Scan Findings mentioning

confidence: 99%

See 2 more Smart Citations

Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

et al. 2019

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“…En outre, un même médicament n'est pas nécessairement associé au même type d'atteinte [3,15,16], par exemple le nivolumab est responsable de SDRA ou de pneumonie organisée [17,18] ;…”

Section: Introductionunclassified

Toxicité pulmonaire des médicaments : ce que le réanimateur doit connaître ?

Parrot

Gibelin

Issoufaly

et al. 2018

Méd. Intensive Réa.

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Résumé Le diagnostic d'insuffisance respiratoire aiguë d'origine médicamenteuse est un véritable défi. Les traitements à l'origine d'une toxicité pulmonaire sont très nombreux. Les nouveaux traitements, notamment en oncohématologie (thé-rapie ciblée, immunothérapie), ne sont pas en reste. L'expression clinique très hétérogène est sous-tendue par des mécanis-mes lésionnels très différents. Après avoir écarté une infection ou un oedème pulmonaire, il faut savoir évoquer une pneumopathie médicamenteuse. La réalisation d'un scanner thoracique et d'une fibroscopie bronchique avec lavage bronchoalvéolaire peut être utile pour exclure une pathologie infectieuse et suggérer une pathologie médicamenteuse. Le traitement est l'arrêt du médicament et repose fréquemment dans ces formes graves sur une corticothérapie. Mots clés Détresse respiratoire · Pneumopathie médicamenteuse · Toxicité pulmonaireAbstract Acute respiratory failure related to drug toxicity is challenging. Several drugs, also including targeted therapy and immunotherapy, have been reported to induce lung toxicity. Clinical and pathological presentations are heterogeneous suggesting different toxicity pulmonary mechanisms. Infection or pulmonary edema should be ruled out, and then drug-induced pneumonitis diagnosis should be considered. CT scan and bronchoscopy with bronchoalveolar lavage are helpful for the disease diagnosis. Due to the severity, the identified drug should be stopped and more frequently steroids should be started.

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Cancer Treatment-Related Lung Injury

Shannon

2019

Oncologic Critical Care

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Lung injury associated with cancer therapeutics is often the limiting factor that trumps otherwise successful cancer therapy. Thoracic radiation as well as cancer pharmacotherapeutics, including conventional chemotherapy, molecular targeted agents, and cancer immunotherapies, have been associated with a unique spectrum of histopathologic injury patterns that may involve the lung parenchyma, pleura, airways, and/or pulmonary vasculature. Injury patterns may be idiosyncratic, unpredictable, and highly variable from one agent class to the next. Variability in lung injury patterns within a specific therapeutic class of drugs also occurs, adding to the conundrum. Drug-induced toxicities to the thoracic cavity are infrequent, and early recognition of clinical clues portends a good outcome in most cases. Failure to recognize early clinical signs, however, may result in irreversible and potentially lethal consequences. This chapter provides an overview of our current knowledge of thoracic complications associated with cancer pharmacotherapies.

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Nivolumab-induced organizing pneumonitis in a patient with lung sarcomatoid carcinoma

Cited by 38 publications

References 15 publications

Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer

Toxicité pulmonaire des médicaments : ce que le réanimateur doit connaître ?

Cancer Treatment-Related Lung Injury

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