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Chronic immune checkpoint inhibitor pneumonitis
Jarushka Naidoo1,2, Tricia R Cottrell3, Evan J Lipson4,2
1Oncology, Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA jnaidoo1@jhmi.edu.
Journal for Immunotherapy of Cancer
|June 20, 2020
Summary
A small percentage of patients treated with immune checkpoint inhibitors (ICI) develop chronic ICI pneumonitis, requiring prolonged immunosuppression. This condition presents distinct features and necessitates long-term management strategies.
Area of Science:
- Oncology
- Immunology
- Pulmonology
Background:
- Immune checkpoint inhibitors (ICI) targeting PD-1/PD-L1 can cause fatal pneumonitis, an immune-related adverse event (irAE).
- Standard treatment involves 4-6 weeks of corticosteroids, but some cases require longer immunosuppression.
Purpose of the Study:
- To determine the incidence, clinicopathological features, and management of chronic ICI pneumonitis.
- To characterize patients with non-small cell lung cancer (NSCLC) and melanoma who develop chronic ICI pneumonitis.
Main Methods:
- Retrospective review of ICI-treated patients with advanced melanoma and NSCLC (Jan 2011-July 2018).
- Definition of chronic ICI pneumonitis: persistence/worsening with steroid tapering, requiring ≥12 weeks immunosuppression.
- Analysis of CT scans, bronchoalveolar lavage fluid (BALF), and lung biopsy (H&E, mIF).
Main Results:
- Overall incidence of chronic ICI pneumonitis was 2% (6/299 patients).
- Majority of chronic cases were in NSCLC patients (5/6); all had disease control and no other irAEs.
- Chronic ICI pneumonitis required a median of 37 weeks of steroids, with characteristic BALF lymphocytosis and organizing pneumonia on biopsy.
Conclusions:
- A subset of patients develop chronic ICI pneumonitis, necessitating prolonged immunosuppression (≥12 weeks).
- Chronic ICI pneumonitis has distinct clinicopathological features requiring tailored management approaches.
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