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Immune Checkpoint Inhibitor-associated Pneumonitis: A Narrative Review.

Chang Li¹, Saadia A Faiz², Megan Boysen-Osborn³

¹McGovern Medical School at University of Texas Health, Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, Houston, Texas.

The Western Journal of Emergency Medicine

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Summary

Immune checkpoint inhibitors (ICI) can cause serious lung inflammation (pneumonitis). Early diagnosis and management are crucial for patients receiving ICI therapy to improve outcomes.

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Multiplexed Immunofluorescence Analysis and Quantification of Intratumoral PD-1+ Tim-3+ CD8+ T Cells

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Area of Science:

Oncology
Pulmonology
Immunology

Background:

Immune checkpoint inhibitors (ICI) improve cancer survival but can cause immune-related adverse events (irAE).
Pulmonary irAE, particularly pneumonitis, are potentially fatal and require critical care in 40% of patients.
ICI-associated pneumonitis presents variably and can mimic infections, complicating diagnosis.

Purpose of the Study:

To provide a framework for diagnosing and managing ICI-associated pneumonitis.
To highlight diagnostic challenges and other contributors to respiratory symptoms.
To guide multidisciplinary management of this critical condition.

Main Methods:

Literature review and synthesis of clinical data on ICI-associated pneumonitis.
Analysis of diagnostic criteria and management strategies.
Emphasis on differentiating pneumonitis from infections and other respiratory conditions.

Main Results:

ICI-associated pneumonitis onset is variable (days to months) and symptoms can be subtle.
Extrapulmonary irAE suggest concurrent pneumonitis.
Distinguishing pneumonitis from respiratory infections requires thorough evaluation.

Conclusions:

A multidisciplinary approach and severity classification are key for managing ICI-associated pneumonitis.
Prompt diagnosis and intervention, including immunosuppression for severe cases, are vital.
Understanding diagnostic challenges improves patient care in the emergency setting.