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Managing Pulmonary Toxicities Associated with Immunotherapy: A Case Discussion
Vanessa A Reed1, Naiyer Rizvi2
1Columbia University Medical Center, New York New York, USA.
The Oncologist
|March 23, 2019
Summary
Effective management of immune-mediated pneumonitis from immune checkpoint inhibitors involves aggressive treatment and careful monitoring. Discontinuation of anti-PD-1 therapy until steroids are completed may allow for durable responses.
Area of Science:
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) have transformed cancer treatment.
- Immune-mediated adverse events, particularly pneumonitis, pose significant challenges.
Observation:
- Grade 3 or greater pneumonitis requires rapid intervention and aggressive management.
- Steroid taper should be slow, with consideration for Pneumocystis pneumonia prophylaxis.
Findings:
- Pneumonitis flares can occur during steroid taper, even without anti-PD-1 therapy.
- Resuming anti-PD-1 therapy should be deferred until steroids are discontinued and no recurrence is evident.
Implications:
- Observation without anti-PD-1 resumption can maintain durable responses.
- Careful management strategies are crucial for managing ICI-induced pneumonitis.
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