Pneumocystis pneumonia in patient with lung adenocarcinoma: early side effects from pembrolizumab

Zahi, Hiba; Hosni, Abdelmoughit; Houssaini, Z. Iraqi; Hounaida, Jerguigue; Latib, Rachida; Omor, Youssef

doi:10.1016/j.radcr.2022.07.083

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…In the present patient, IL-6 and TNF-α, inflammatory cytokines released by M1 macrophages at the development of PCP, were elevated, which is consistent with this speculation. Previous cases of PCP during ICI administration were preceded by a history of cytotoxic chemotherapy and steroid administration (15,16), and there have been no reports of PCP during ICI administration in patients without an obvious history of immunosuppressive treatment, such as our case.…”

Section: Discussionmentioning

confidence: 75%

Pneumocystis Pneumonia Infection Following the Initiation of Pembrolizumab Therapy for Lung Adenocarcinoma

et al. 2023

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Pneumocystis pneumonia (PCP) is an opportunistic infection that presents a ground-glass appearance in the lungs on chest radiography. Interstitial lung disease is a commonly reported adverse effect of immune checkpoint inhibitor (ICI) treatment; however, there are few reports of ICI treatment-associated PCP infection. A 77-year-old man with lung adenocarcinoma was administered pembrolizumab and hospitalized for dyspnea 2 weeks after treatment. Chest computed tomography showed bilateral ground-glass opacities in all lung lobes. PCP was therefore diagnosed, and steroids and sulfamethoxazole-trimethoprim were initiated. Following treatment, the patient's condition improved promptly. This report suggests that ICI treatment can cause PCP infection.

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Section: Discussionmentioning

confidence: 75%

Pneumocystis Pneumonia Infection Following the Initiation of Pembrolizumab Therapy for Lung Adenocarcinoma

et al. 2023

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“…Firstly, our post-marketing pharmacovigilance analysis showed that PJP was significantly associated with ICIs. Previous case reports (Arriola et al, 2015;Finbar Slevin et al, 2016;Schwarz et al, 2019;Liu et al, 2020;Moujaess et al, 2020;Sadek et al, 2020;Feng et al, 2021;Rath et al, 2021;Si et al, 2021;Hiba et al, 2022) showed that PJP may be a complication in immunotherapy. But the sample size is small.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) recommended that primary prophylaxis of Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors are warranted ( Classen et al, 2021 ). To the best of our knowledge, only a few case reports/series have described Pneumocystis jirovecii pneumonia (PJP) during pembrolizumab ( Liu et al, 2020 ; Sadek et al, 2020 ; Rath et al, 2021 ; Si et al, 2021 ; Hiba et al, 2022 ; Sanka and Hsu, 2023 ), nivolumab ( Schwarz et al, 2019 ), ipilimumab ( Arriola et al, 2015 ; Finbar Slevin et al, 2016 ; Sadek et al, 2020 ), nivolumab plus ipilimumab ( Moujaess et al, 2020 ) and other anti-PD-1 inhibitors ( Liu et al, 2020 ; Feng et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis jirovecii pneumonia associated with immune checkpoint inhibitors: A systematic literature review of published case reports and disproportionality analysis based on the FAERS database

et al. 2023

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Background: Pneumocystis jirovecii pneumonia (PJP) has been reported with ICIs but limited to case reports. The clinical features of PJP with ICIs remain mostly unknown. This study aims to investigate the association of PJP with ICIs and describe clinical features.Methods: Reports of PJP recorded in FAERS (January 2004–December 2022) were identified through the preferred term “Pneumocystis jirovecii pneumonia”. Demographic and clinical features were described, and disproportionality signals were assessed through the Reporting Odds Ratio (ROR) and Information Component (IC), using traditional chemotherapy and targeted therapy as comparators, and adjusting signals by excluding contaminant immunosuppressive drugs and pre-existing diseases. A systematic literature review was conducted to describe clinical features of published PJP reports with ICIs. Bradford Hill criteria was adopted for global assessment of the evidence.Results: We identified 677 reports of PJP associated with ICIs, in which 300 (44.3%) PJP cases with fatal outcome. Nivolumab (IC025 2.05), pembrolizumab (IC025 1.88), ipilimumab (IC025 1.43), atezolizumab (IC025 0.36), durvalumab (IC025 1.65), nivolumab plus ipilimumab (IC025 1.59) have significant signals compared to other drugs in FAERS database. After excluding pre-existing diseases and immunosuppressive agents which may increase susceptibility of PJP, the signals for PJP associated with nivolumab, pembrolizumab, durvalumab, nivolumab plus ipilimumab remained robust (IC025 > 0). When compared to other anticancer regimens, although all ICIs showed a lower disproportionate signal for PJP than chemotherapy, nivolumab (IC025 0.33, p < 0.001), pembrolizumab (IC025 0.16, p < 0.001), both PD-1 inhibitors, presented a higher signal for PJP than targeted therapy. Male gender (IC025 0.26, p < 0.001) and age >65 years (IC025 0.38, p < 0.001) were predominant in PJP cases associated with across all ICIs. In literature, 15 PJP cases associated with ICIs were reported in 10 published case reports. 12 of 15 (80.0%) of cases received PD-1 inhibitors before PJP was diagnosed.Conclusion: By the combined analysis of post-marketing data from FAERS and published case reports, we identified ICIs may be associated with PJP, especially in males aged >65years. After accounting for confounders, PD-1 inhibitors emerged with a robust disproportionality signal when compared to PD-L1/CTLA-4 inhibitors as well as targeted therapy. Further research is warranted to validate our findings.

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Carboplatin/paclitaxel/pembrolizumab

2022

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Pneumocystis pneumonia in patient with lung adenocarcinoma: early side effects from pembrolizumab

Cited by 3 publications

References 13 publications

Pneumocystis Pneumonia Infection Following the Initiation of Pembrolizumab Therapy for Lung Adenocarcinoma

Pneumocystis Pneumonia Infection Following the Initiation of Pembrolizumab Therapy for Lung Adenocarcinoma

Pneumocystis jirovecii pneumonia associated with immune checkpoint inhibitors: A systematic literature review of published case reports and disproportionality analysis based on the FAERS database

Carboplatin/paclitaxel/pembrolizumab

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