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Hindocha S, Hunter B, Linton-Reid K, George Charlton T, Chen M, Logan A, Ahmed M, Locke I, Sharma B, Doran S, Orton M, Bunce C, Power D, Ahmad S, Chan K, Ng P, Toshner R, Yasar B, Conibear J, Murphy R, Newsom-Davis T, Goodley P, Evison M, Yousaf N, Bitar G, McDonald F, Blackledge M, Aboagye E, Lee R. Validated machine learning tools to distinguish immune checkpoint inhibitor, radiotherapy, COVID-19 and other infective pneumonitis. Radiother Oncol 2024; 195:110266. [PMID: 38582181 DOI: 10.1016/j.radonc.2024.110266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Pneumonitis is a well-described, potentially disabling, or fatal adverse effect associated with both immune checkpoint inhibitors (ICI) and thoracic radiotherapy. Accurate differentiation between checkpoint inhibitor pneumonitis (CIP) radiation pneumonitis (RP), and infective pneumonitis (IP) is crucial for swift, appropriate, and tailored management to achieve optimal patient outcomes. However, correct diagnosis is often challenging, owing to overlapping clinical presentations and radiological patterns. METHODS In this multi-centre study of 455 patients, we used machine learning with radiomic features extracted from chest CT imaging to develop and validate five models to distinguish CIP and RP from COVID-19, non-COVID-19 infective pneumonitis, and each other. Model performance was compared to that of two radiologists. RESULTS Models to distinguish RP from COVID-19, CIP from COVID-19 and CIP from non-COVID-19 IP out-performed radiologists (test set AUCs of 0.92 vs 0.8 and 0.8; 0.68 vs 0.43 and 0.4; 0.71 vs 0.55 and 0.63 respectively). Models to distinguish RP from non-COVID-19 IP and CIP from RP were not superior to radiologists but demonstrated modest performance, with test set AUCs of 0.81 and 0.8 respectively. The CIP vs RP model performed less well on patients with prior exposure to both ICI and radiotherapy (AUC 0.54), though the radiologists also had difficulty distinguishing this test cohort (AUC values 0.6 and 0.6). CONCLUSION Our results demonstrate the potential utility of such tools as a second or concurrent reader to support oncologists, radiologists, and chest physicians in cases of diagnostic uncertainty. Further research is required for patients with exposure to both ICI and thoracic radiotherapy.
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Affiliation(s)
- Sumeet Hindocha
- Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW36JJ, UK; Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK.
| | - Benjamin Hunter
- Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - Kristofer Linton-Reid
- Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Thomas George Charlton
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE19RT, UK
| | - Mitchell Chen
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Andrew Logan
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Merina Ahmed
- Lung Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM25PT, UK
| | - Imogen Locke
- Lung Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM25PT, UK
| | - Bhupinder Sharma
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - Simon Doran
- Institute of Cancer Research NIHR Biomedical Research Centre, London, UK
| | - Matthew Orton
- Artificial Intelligence Imaging Hub, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM25PT, UK
| | - Catey Bunce
- Institute of Cancer Research NIHR Biomedical Research Centre, London, UK
| | - Danielle Power
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Shahreen Ahmad
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE19RT, UK
| | - Karen Chan
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE19RT, UK
| | - Peng Ng
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE19RT, UK
| | - Richard Toshner
- Interstitial lung disease unit, St Bartholomews' Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Binnaz Yasar
- Department of Clinical Oncology, St Batholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - John Conibear
- Department of Clinical Oncology, St Batholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Ravindhi Murphy
- Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Tom Newsom-Davis
- Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Patrick Goodley
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Greater Manchester, UK; Division of Immunology, Immunity to Infection & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Greater Manchester, UK
| | - Nadia Yousaf
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - George Bitar
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - Fiona McDonald
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - Matthew Blackledge
- Radiotherapy and Imaging, Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Eric Aboagye
- Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Richard Lee
- Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW36JJ, UK
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Rogiers A, Dimitriou F, Lobon I, Harvey C, Vergara IA, Pires da Silva I, Lo SN, Scolyer RA, Carlino MS, Menzies AM, Long GV. Seasonal patterns of toxicity in melanoma patients treated with combination anti-PD-1 and anti-CTLA-4 immunotherapy. Eur J Cancer 2024; 198:113506. [PMID: 38184928 DOI: 10.1016/j.ejca.2023.113506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors are frequently associated with the development of immunotherapy-related adverse events (irAEs). The exact etiology, including the role of environmental factors, remains incompletely understood. METHODS We analyzed the records of 394 melanoma patients from three centers (northern and southern hemisphere). Patients had received at least one cycle of anti-PD-1/anti-CTLA-4 with a minimum follow-up of 3 months. We study the distribution and time to irAEs onset throughout the calendar year. RESULTS 764 irAEs were recorded; the most frequent were skin rash (35%), hepatitis (32%) and colitis (30%). The irAEs incidence was the highest in autumn and winter, and the ratio for the 'number of irAEs' per 'therapies commenced' was the highest in winter and lowest in summer (2.4 and 1.7, respectively). Season-specific patterns in the time of irAEs onset were observed for pneumonitis (shorter time to onset in autumn, p = 0.025), hepatitis (shorter time to onset in spring, p = 0.016) and sarcoid-like immune reaction (shorter time to onset in autumn, p = 0.041). Season-specific patterns for early-onset irAEs were observed for hepatitis (spring, p = 0.023) and nephritis (summer, p = 0.017). Early-onset pneumonitis was more frequent in autumn-winter (p = 0.008) and early-onset nephritis in spring-summer (p = 0.004). CONCLUSIONS Environmental factors that are associated with particular seasons may contribute to the development of certain irAEs and suggest the potential effect of environmental triggers. The identification of these factors may enhance preventive and therapeutic strategies to reduce the morbidity of irAEs.
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Affiliation(s)
- Aljosja Rogiers
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Florentia Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Irene Lobon
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Catriona Harvey
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkin Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ismael A Vergara
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkin Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ines Pires da Silva
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
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Gao R, Yang F, Yang C, Zhang Z, Liu M, Xiang C, Hu H, Luo X, Li J, Liu R. A case report and literature review of immune checkpoint inhibitor-associated pneumonia caused by penpulimab. Front Immunol 2023; 14:1114994. [PMID: 37426639 PMCID: PMC10323425 DOI: 10.3389/fimmu.2023.1114994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Objective From the perspective of intensive care physicians, this paper reviews the diagnosis and treatment of CIP patients, analyzes and refines relevant literature on CIP. To summarize the characteristics of diagnosis and treatment of severe CIP provides the basis and reference for early identification, diagnosis and treatment. Methods A case of severe CIP caused by piamprilizumab and ICI was reviewed and the literature was reviewed. Results This was a patient with lung squamous cell carcinoma with lymphoma who had been treated with multiple chemoradiotherapy and immunotherapy with piamprizumab. The patient was admitted to the ICU with respiratory failure. The intensive care physician performs anti-infective, fluid management, hormonal anti-inflammatory, respiratory and nutritional support treatment, and relies on mNGS to exclude severe infection and CIP treatment, thus successfully saving the patient's life and improving discharge. Conclusions The incidence of CIP is very low, and its diagnosis should be combined with clinical manifestations and previous drug use. mNGS can provide certain value in the exclusion of severe infections, so as to provide basis and reference for the early identification, diagnosis and treatment of severe CIP.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiaoxiu Luo
- *Correspondence: Xiaoxiu Luo, ; Jiajia Li, ; Rongan Liu,
| | - Jiajia Li
- *Correspondence: Xiaoxiu Luo, ; Jiajia Li, ; Rongan Liu,
| | - Rongan Liu
- *Correspondence: Xiaoxiu Luo, ; Jiajia Li, ; Rongan Liu,
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Frost N, Unger K, Gerriet Blum T, Misch D, Kurz S, Lüders H, Olive E, Raspe M, Hilbrandt M, Koch M, Böhmer D, Senger C, Witzenrath M, Grohé C, Bauer T, Modest DP, Kollmeier J. Management, risk factors and prognostic impact of checkpoint-inhibitor pneumonitis (CIP) in lung cancer – A multicenter observational analysis. Lung Cancer 2023; 179:107184. [PMID: 37040677 DOI: 10.1016/j.lungcan.2023.107184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Checkpoint-inhibitor pneumonitis (CIP) represents a major immune-related adverse event (irAE) in patients with lung cancer. We aimed for the clinical characterization, diagnostics, risk factors, treatment and outcome in a large cohort of patients from everyday clinical practice. PATIENTS AND METHODS For this retrospective analysis, 1,376 patients having received checkpoint inhibitors (CPI) in any line of therapy from June 2015 until February 2020 from three large-volume lung cancer centers in Berlin, Germany were included and analyzed. RESULTS With a median follow-up of 35 months, all-grade, high-grade (CTCAE ≥ 3) and fatal CIP were observed in 83 (6.0%), 37 (2.7%) and 12 (0.9%) patients, respectively, with a median onset 4 months after initiation of CPI therapy. The most common radiologic patterns were organizing pneumonia (OP) and non-specific interstitial pneumonia (NSIP) (37% and 31%). All except 7 patients with G1-2 CIP interrupted treatment. Corticosteroids were administered to 74 patients with a median starting dose of 0.75 mg/kg. After complete restitution (n = 67), re-exposure to CPI (n = 14) led to additional irAE in 43% of the cases. Thoracic radiotherapy targeting the lung was the only independent risk factor for CIP (odds ratio 2.8, p < 0.001) and pretherapeutic diffusing capacity for carbon monoxide inversely correlated with CIP severity. Compared with patients without CIP and non-CIP irAE, CIP was associated with impaired overall survival (hazard ratios 1.23, p = 0.24 and 2.01, p = 0.005). CONCLUSIONS High-grade CIP accounts for almost half of all CIP cases in an allcomer lung cancer population. A continuous vigilance, rapid diagnostics and adequate treatment are key to prevent disease progression associated with impaired survival.
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Guo XJ, Cai XT, Rong ZX, Zhang YP, Wen YX, Bai X, Wang J, Fu QJ, Guo ZQ, Long LL, Ma SC, Tang XR, Liu L, Guan J, Dong ZY, Wu DH. Interstitial pneumonitis associated with combined regimen of immunotherapy and conventional therapies-pharmacovigilance database analysis with real-world data validation. BMC Med 2023; 21:6. [PMID: 36600276 PMCID: PMC9814324 DOI: 10.1186/s12916-022-02713-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) therapy combined with conventional therapies is being broadly applied in non-small cell lung cancer (NSCLC) patients. However, the risk of interstitial pneumonitis (IP) following a combined regimen is incompletely characterized. METHODS A total of 46,127 NSCLC patients were extracted for disproportionality analyses of IP from the Food and Drug Administration's Adverse Event Reporting System (FAERS) database. A total of 1108 NSCLC patients who received ICI treatment at Nanfang Hospital of Southern Medical University were collected and utilized for real-world validation. RESULTS Of the 46,127 patients with NSCLC, 3830 cases (8.3%; 95% confidence interval [CI], 8.05-8.56) developed IP. Multivariable logistic regression analyses revealed that the adjusted ROR of ICI combined with radiation (RT) was the highest (121.69; 95% CI, 83.60-184.96; P < 0.0001) among all therapies, while that of ICI combined with chemotherapy (CHEMO) or targeted therapy (TARGET) was 0.90 (95% CI, 0.78-1.04; P = 0.160) and 1.49 (95% CI, 0.95-2.23; P = 0.065), respectively, using ICI monotherapy as reference. Furthermore, analyses from our validation cohort of 1108 cases showed that the adjusted odds ratio of ICI combined with RT was the highest (12.25; 95% CI, 3.34-50.22; P < 0.01) among all the therapies, while that of ICI combined with CHEMO or TARGET was 2.32 (95% CI, 0.89-7.92; P = 0.12) and 0.66 (95% CI, 0.03-4.55; P = 0.71), respectively, using ICI monotherapy as reference. CONCLUSIONS Compared with ICI monotherapy, ICI combined with RT, rather than with CHEMO or TARGET, is associated with a higher risk of IP in NSCLC patients. Hence, patients receiving these treatments should be carefully monitored for IP.
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Affiliation(s)
- Xue-Jun Guo
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xiao-Ting Cai
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Zi-Xuan Rong
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Yan-Pei Zhang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Yu-Xiang Wen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xue Bai
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Jian Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Qiang John Fu
- Department of Community Health, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Ze-Qin Guo
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Li-Li Long
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Si-Cong Ma
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xin-Ran Tang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Li Liu
- Information Management and Big Data Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Guan
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Zhong-Yi Dong
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - De-Hua Wu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
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Wu Y, Yin Y, Yan X, Fang L, Sun J. Late‑onset immune checkpoint inhibitor‑related pneumonitis after cessation of sintilimab: A case report and literature review. Exp Ther Med 2023; 25:83. [PMID: 36741913 PMCID: PMC9852418 DOI: 10.3892/etm.2023.11782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/11/2022] [Indexed: 01/04/2023] Open
Abstract
Immune-related adverse events following treatment with immune checkpoint inhibitors (ICIs) can occur at any time during therapy, with onset occurring most frequently during the first 3 months of treatment. However, they rarely occur after treatment cessation. An awareness of delayed immune-related events following the termination of immunotherapy is paramount for optimal tumour management. The present study reports a case of a 69-year-old male patient with right lung adenocarcinoma. He suffered from psoriasis for ~40 years and was suspected of developing immune checkpoint inhibitor-related pneumonitis (CIP) 6 months after the cessation of treatment with the anti-programmed cell death-1 receptor antibody sintilimab. The present case study is, to the best of our knowledge, the first case of late-onset CIP after the cessation of sintilimab. Subsequently, the report also reviews previously reported cases of late-onset CIP after the cessation of ICI treatment. The present report highlights the finding that CIP can develop, although rarely reported, months or even years after the termination of immunotherapy. Therefore, CIP should always be considered as one of the possibilities and addressed accordingly once the pulmonary infection is ruled out. Careful monitoring, timely diagnosis and administration of corticosteroids are essential in controlling this condition, particularly for patients with pre-existing autoimmune diseases.
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Affiliation(s)
- Yupei Wu
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China,Correspondence to: Dr Yupei Wu, Department of Pharmacy, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei 050051, P.R. China
| | - Yuesong Yin
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Xiaolu Yan
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Lingzhi Fang
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Jiewei Sun
- Department of Pharmacy, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei 050051, P.R. China
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Zhang A, Yang F, Gao L, Shi X, Yang J. Research Progress on Radiotherapy Combined with Immunotherapy for Associated Pneumonitis During Treatment of Non-Small Cell Lung Cancer. Cancer Manag Res 2022; 14:2469-2483. [PMID: 35991677 PMCID: PMC9386171 DOI: 10.2147/cmar.s374648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation pneumonitis is a common and serious complication of radiotherapy for thoracic tumours. Although radiotherapy technology is constantly improving, the incidence of radiation pneumonitis is still not low, and severe cases can be life-threatening. Once radiation pneumonitis develops into radiation fibrosis (RF), it will have irreversible consequences, so it is particularly important to prevent the occurrence and development of radiation pneumonitis. Immune checkpoint inhibitors (ICIs) have rapidly altered the treatment landscape for multiple tumour types, providing unprecedented survival in some patients, especially for the treatment of non-small cell lung cancer (NSCLC). However, in addition to its remarkable curative effect, ICls may cause immune-related adverse events. The incidence of checkpoint inhibitor pneumonitis (CIP) is 3% to 5%, and its mortality rate is 10% to 17%. In addition, the incidence of CIP in NSCLC is higher than in other tumour types, reaching 7%–13%. With the increasing use of immune checkpoint inhibitors (ICls) and thoracic radiotherapy in the treatment of patients with NSCLC, ICIs may induce delayed radiation pneumonitis in patients previously treated with radiation therapy, or radiation activation of the systemic immune system increases the toxicity of adverse reactions, which may lead to increased pulmonary toxicity and the incidence of pneumonitis. In this paper, the data about the occurrence of radiation pneumonitis, immune pneumonitis, and combined treatment and the latest related research results will be reviewed.
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Affiliation(s)
- Anqi Zhang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
| | - Fuyuan Yang
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, People's Republic of China
| | - Lei Gao
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
| | - Xiaoyan Shi
- Department of Gynaecology and Obstetrics, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
| | - Jiyuan Yang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, People's Republic of China
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Establishment and Validation of a Predictive Model for Radiation-Associated Aspiration Pneumonia in Patients with Radiation-Induced Dysphagia after Nasopharyngeal Carcinoma. Behav Neurol 2022; 2022:6307804. [PMID: 36039334 PMCID: PMC9418526 DOI: 10.1155/2022/6307804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Radiotherapy for patients with head and neck cancers raises their risk of aspiration pneumonia-related death. We aimed to develop and validate a model to predict radiation-associated aspiration pneumonia (RAP) among patients with dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC). Materials and Methods A total of 453 dysphagic patients with NPC were retrospectively recruited from Sun Yat-Sen Memorial Hospital from January 2012 to January 2018. Patients were randomly divided into training cohort (n = 302) and internal validation cohort (n = 151) at a ratio of 2 : 1. The concordance index (C-index) and calibration curve were used to evaluate the accuracy and discriminative ability of this model. Moreover, decision curve analysis was performed to evaluate the net clinical benefit. The results were externally validated in 203 dysphagic patients from the First People's Hospital of Foshan. Results Derived from multivariable analysis of the training cohort, four independent factors were introduced to predict RAP, including Kubota water drinking test grades, the maximum radiation dose of lymph node gross tumor volume (Dmax of the GTVnd), neutrophil count, and erythrocyte sedimentation rate (ESR). The nomogram showed favorable calibration and discrimination regarding the training cohort, with a C-index of 0.749 (95% confidence interval (CI), 0.681 to 0.817), which was confirmed by the internal validation cohort (C-index 0.743; 95% CI, 0.669 to 0.818) and the external validation cohort (C-index 0.722; 95% CI, 0.606 to 0.838). Conclusions Our study established and validated a simple nomogram for RAP among patients with dysphagia after radiotherapy for NPC.
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Sun F, Wang D, Liu A, Wang T, Zhang D, Yao H, Sun K, Zhou Z, Lu G, Wu J. Efficacy and Adverse Events of PD-1 Inhibitors in Patients With Advanced Urothelial Carcinoma From a Real-World Experience. Front Pharmacol 2022; 13:837499. [PMID: 35370654 PMCID: PMC8971813 DOI: 10.3389/fphar.2022.837499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Programmed death 1 (PD-1) inhibitors—tislelizumab, toripalimab, camrelizumab, and sintilimab—are used for advanced urothelial carcinoma (UC) in China. To date, the efficacy and adverse events (AEs) of these PD-1 inhibitors have been poorly reported for advanced UC.Methods: We reviewed 118 patients treated with PD-1 inhibitors for advanced UC from July 2019 to October 2021 at Yantai Yuhuangding Hospital. Patient data were obtained from hospital records and telephone follow-ups. The safety and efficacy of PD-1 inhibitors were assessed by RESIST and Common Terminology Criteria for Adverse Events (version 4.0), respectively.Results: During a median follow-up period of 6 months, 112 patients (95%) experienced AEs; of these, 104 (88%) were grade 1–2 AEs, and 60 (51%) were grade 3–4 AEs. The most common AE was anemia, and no patients died as a result of treatment. A subanalysis according to treatment method (PD-1 inhibitor vs. PD-1 inhibitor plus chemotherapy) was performed. The incidence of grade 1–2 AEs was not different between the groups (85% vs. 94%), but combination therapy significantly increased grade 3–4 AEs (32% vs. 89%). Monotherapy and combination therapy also did not differ with regard to immune-related AEs of grades 1–2 (13% vs. 22%) or grades 3–4 (1% vs. 6%). In efficacy, complete response was not observed, but 33 patients (28%) had partial response, 30 (25%) had stable disease, and 47 had progressive disease (40%). The overall response and disease control rates were 28% and 53%, respectively. The preliminary efficacy of disease control was better with combination therapy versus monotherapy (78 vs. 43%).Conclusion: PD-1 inhibitors show promising tolerance and efficacy in advanced UC. PD-1 inhibitors combined with chemotherapy offered better disease control but had more grade 3–4 AEs. The clinical use of combination therapy warrants caution.
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Affiliation(s)
- Fengze Sun
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Dawei Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Aina Liu
- Department of Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Tianqi Wang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Dongxu Zhang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Huibao Yao
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Kai Sun
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Zhongbao Zhou
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guoliang Lu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jitao Wu, ; Guoliang Lu,
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- *Correspondence: Jitao Wu, ; Guoliang Lu,
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10
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Immune- and Non-Immune-Mediated Adverse Effects of Monoclonal Antibody Therapy: A Survey of 110 Approved Antibodies. Antibodies (Basel) 2022; 11:antib11010017. [PMID: 35323191 PMCID: PMC8944650 DOI: 10.3390/antib11010017] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 12/10/2022] Open
Abstract
Identification of new disease-associated biomarkers; specific targeting of such markers by monoclonal antibodies (mAbs); and application of advances in recombinant technology, including the production of humanized and fully human antibodies, has enabled many improved treatment outcomes and successful new biological treatments of some diseases previously neglected or with poor prognoses. Of the 110 mAbs preparations currently approved by the FDA and/or EMA, 46 (including 13 antibody–drug conjugates) recognizing 29 different targets are indicated for the treatment of cancers, and 66, recognizing 48 different targets, are indicated for non-cancer disorders. Despite their specific targeting with the expected accompanying reduced collateral damage for normal healthy non-involved cells, mAbs, may cause types I (anaphylaxis, urticaria), II (e.g., hemolytic anemia, possibly early-onset neutropenia), III (serum sickness, pneumonitis), and IV (Stevens–Johnson syndrome, toxic epidermal necrolysis) hypersensitivities as well as other cutaneous, pulmonary, cardiac, and liver adverse events. MAbs can provoke severe infusion reactions that resemble anaphylaxis and induce a number of systemic, potentially life-threatening syndromes with low frequency. A common feature of most of these syndromes is the release of a cascade of cytokines associated with inflammatory and immunological processes. Epidermal growth factor receptor-targeted antibodies may provoke papulopustular and mucocutaneous eruptions that are not immune-mediated.
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11
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Pozzessere C, Lazor R, Jumeau R, Peters S, Prior JO, Beigelman-Aubry C. Imaging Features of Pulmonary Immune-related Adverse Events. J Thorac Oncol 2021; 16:1449-1460. [PMID: 34087477 DOI: 10.1016/j.jtho.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/05/2021] [Accepted: 05/16/2021] [Indexed: 11/24/2022]
Abstract
Pulmonary immune-related adverse events represent rare but potentially severe side effects of immunotherapies. Diagnosis is often challenging, as symptoms and imaging features are not specific and may mimic other lung diseases, thus potentially delaying appropriate patient management. In this setting, an accurate imaging evaluation is essential for a prompt detection and correct management of these drug-induced lung diseases. The purpose of this article is to review the different types of pulmonary immune-related adverse events, describe their imaging characteristics on both high-resolution computed tomography and positron emission tomography/computed tomography and stress their underlying diagnostic challenge by presenting the mimickers.
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Affiliation(s)
- Chiara Pozzessere
- Department of Radiology, AUSL Toscana Centro, San Giuseppe Hospital, Empoli, Italy; Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Romain Lazor
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Raphael Jumeau
- Department of Radiation Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Solange Peters
- Medical Oncology Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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12
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Huang A, Xu Y, Zang X, Wu C, Gao J, Sun X, Xie M, Ma X, Deng H, Song J, Ren F, Pang L, Qian J, Yu Z, Wan S, Chen Y, Pan L, Zhuang G, Liu S, Xue X. Radiographic features and prognosis of early- and late-onset non-small cell lung cancer immune checkpoint inhibitor-related pneumonitis. BMC Cancer 2021; 21:634. [PMID: 34051746 PMCID: PMC8164260 DOI: 10.1186/s12885-021-08353-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Immunotherapy is becoming a standard of care for non-small cell lung cancer (NSCLC). Checkpoint inhibitor-associated pneumonia (CIP) is a rare and potentially life-threatening event that can occur at any time during tumor immunotherapy. However, there may be differences in the radiological patterns and prognosis of CIP during different periods. This study aimed to investigate the radiographic features and prognosis of early- and late-onset immune-related pneumonitis. Methods We retrospectively analyzed the clinical data of 677 NSCLC patients receiving immunotherapy to identify 32 patients with CIP, analyzed the clinical and radiographic data, and summarized the radiological features and prognosis of early- and late-onset CIP. Results CIP had an incidence of 4.7%, a median onset time of 10 weeks, and a mortality of 28.1%. Among these, CIP included 14 early-onset cases, where grade ≥ 3 CIP accounted for 92.9%, main radiographic pattern was organizing pneumonia (OP)-like pattern, and mortality was 50.0%. We also identified 18 late-onset CIPs, where grade ≥ 3 CIP accounted for 50.0%, main radiographic pattern was nonspecific interstitial pneumonia (NSIP)-like pattern, and mortality was 11.1%. The overall survival rate of the early-onset group was significantly lower than that of the late-onset group (P < 0.05). Conclusion Early-onset CIP cases were higher in the Common Terminology Criteria for Adverse Events (CTCAE v5.0) grade and mainly presented with an OP-like radiographic pattern; whereas, late-onset CIP cases were lower in CTCAE grade and mainly presented with an NSIP-like radiographic pattern. Finally, the prognosis of the early-onset CIP group was poorer than that of the late-onset CIP group. We believe that this study will be helpful for clinicians for making early diagnosis and deciding treatment modalities for patients with CIP. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08353-y.
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Affiliation(s)
- Aiben Huang
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yang Xu
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, Beijing, China
| | - Xuelei Zang
- Center of Clinical Laboratory Medicine, the first Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chongchong Wu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jie Gao
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoli Sun
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mei Xie
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xidong Ma
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, Beijing, China
| | - Hui Deng
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jialin Song
- Department of Respiratory Medicine, Weifang Medical University, Weifang, China
| | - Fangping Ren
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Li Pang
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jin Qian
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhaofeng Yu
- School of Medicine, Peking University, Beijing, China
| | - Shiyu Wan
- School of Medicine, Peking University, Beijing, China
| | - Yuanyuan Chen
- School of Medicine, Peking University, Beijing, China
| | - Lei Pan
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Guanglei Zhuang
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Sanhong Liu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Xinying Xue
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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13
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Cousin F, Desir C, Ben Mustapha S, Mievis C, Coucke P, Hustinx R. Incidence, risk factors, and CT characteristics of radiation recall pneumonitis induced by immune checkpoint inhibitor in lung cancer. Radiother Oncol 2021; 157:47-55. [DOI: 10.1016/j.radonc.2021.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022]
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14
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Procureur A, Simonaggio A, Bibault JE, Oudard S, Vano YA. Enhance the Immune Checkpoint Inhibitors Efficacy with Radiotherapy Induced Immunogenic Cell Death: A Comprehensive Review and Latest Developments. Cancers (Basel) 2021; 13:678. [PMID: 33567530 PMCID: PMC7915834 DOI: 10.3390/cancers13040678] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
The immunogenic cell death (ICD) is defined as a regulated cell death able to induce an adaptive immunity. It depends on different parameters including sufficient antigenicity, adjuvanticity and favorable microenvironment conditions. Radiation therapy (RT), a pillar of modern cancer treatment, is being used in many tumor types in curative, (neo) adjuvant, as well as metastatic settings. The anti-tumor effects of RT have been traditionally attributed to the mitotic cell death resulting from the DNA damages triggered by the release of reactive oxygen species. Recent evidence suggests that RT may also exert its anti-tumor effect by recruiting tumor-specific immunity. RT is able to induce the release of tumor antigens, to act as an immune adjuvant and thus to synergize with the anti-tumor immunity. The advent of new efficient immunotherapeutic agents, such as immune checkpoint inhibitors (ICI), in multiple tumor types sheds new light on the opportunity of combining RT and ICI. Here, we will describe the biological and radiobiological rationale of the RT-induced ICD. We will then focus on the interest to combine RT and ICI, from bench to bedside, and summarize the clinical data existing with this combination. Finally, RT technical adaptations to optimize the ICD induction will be discussed.
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Affiliation(s)
- Adrien Procureur
- Hôpital Européen Georges Pompidou, Service d’Oncologie Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP) Paris-Centre, F-75015 Paris, France; (A.P.); (A.S.); (S.O.)
| | - Audrey Simonaggio
- Hôpital Européen Georges Pompidou, Service d’Oncologie Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP) Paris-Centre, F-75015 Paris, France; (A.P.); (A.S.); (S.O.)
| | - Jean-Emmanuel Bibault
- Hôpital Européen Georges Pompidou, Service d’Oncologie Radiothérapie, Assistance Publique-Hôpitaux de Paris (AP-HP) Paris-Centre, F-75015 Paris, France;
| | - Stéphane Oudard
- Hôpital Européen Georges Pompidou, Service d’Oncologie Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP) Paris-Centre, F-75015 Paris, France; (A.P.); (A.S.); (S.O.)
| | - Yann-Alexandre Vano
- Hôpital Européen Georges Pompidou, Service d’Oncologie Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP) Paris-Centre, F-75015 Paris, France; (A.P.); (A.S.); (S.O.)
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, F-75006 Paris, France
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15
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Gomatou G, Tzilas V, Kotteas E, Syrigos K, Bouros D. Immune Checkpoint Inhibitor-Related Pneumonitis. Respiration 2020; 99:932-942. [PMID: 33260191 DOI: 10.1159/000509941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Immune checkpoint inhibitors are novel agents that have been proved efficacious in a variety of cancer types, but they are associated with a unique set of organ-specific, immune-related adverse events. Among them, immune-related pneumonitis requires special attention because it is difficult to diagnose and potentially lethal. Accumulating real-world epidemiological data suggest that immune-related pneumonitis is more frequent than previously reported. Its diagnosis requires exclusion of other causes and assessment of radiographic features on high-resolution CT of the chest. Management of immune-related pneumonitis is based on the use of immunosuppressants. Future research should be focused on finding predictive biomarkers for immune-related pneumonitis as well as optimizing its management.
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Affiliation(s)
- Georgia Gomatou
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece, .,Oncology Unit, 3rd Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece,
| | - Vasilios Tzilas
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Kotteas
- Oncology Unit, 3rd Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Syrigos
- Oncology Unit, 3rd Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- Interstitial Lung Diseases Unit, 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
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16
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Papa A, Pozzessere C, Cicone F, Rizzuto F, Cascini GL. Not all that glitters is COVID! Differential diagnosis of FDG-avid interstitial lung disease in low-prevalence regions. Eur J Hybrid Imaging 2020; 4:19. [PMID: 33103048 PMCID: PMC7568945 DOI: 10.1186/s41824-020-00088-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/03/2020] [Indexed: 01/11/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) is only one of the many possible infectious and non-infectious diseases that may occur with similar imaging features in patients undergoing [18F]-fluorodeoxyglucose (18FDG) monitoring, particularly in the most fragile oncologic patients. We briefly summarise some key radiological elements of differential diagnosis of interstitial lung diseases which, in our opinion, could be extremely useful for physicians reporting 18FDG PET/CT scans, not only during the COVID-19 pandemic, but also for their normal routine activity.
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Affiliation(s)
- Annalisa Papa
- Nuclear Medicine Unit, University Hospital "Mater Domini", Catanzaro, Italy
| | - Chiara Pozzessere
- Radiology Unit, AUSL Toscana Centro San Giuseppe Hospital, Empoli, Italy
| | - Francesco Cicone
- Nuclear Medicine Unit, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Viale Europa - 88100, Catanzaro, Italy
| | - Fabiola Rizzuto
- Medical Oncology Unit, Hospital "Pugliese Ciaccio", Catanzaro, Italy
| | - Giuseppe Lucio Cascini
- Nuclear Medicine Unit, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Viale Europa - 88100, Catanzaro, Italy
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17
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Barrón F, Sánchez R, Arroyo-Hernández M, Blanco C, Zatarain-Barrón ZL, Catalán R, Ramos-Ramírez M, Cardona AF, Flores-Estrada D, Arrieta O. Risk of Developing Checkpoint Immune Pneumonitis and Its Effect on Overall Survival in Non-small Cell Lung Cancer Patients Previously Treated With Radiotherapy. Front Oncol 2020; 10:570233. [PMID: 33117699 PMCID: PMC7550759 DOI: 10.3389/fonc.2020.570233] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Immune checkpoint inhibitor-related pneumonitis (ICIP) is a potentially life threatening immune-related adverse event (irAE), especially in non-small cell lung cancer (NSCLC) patients. Currently, the potential for increased irAE in patients who receive radiotherapy is scarcely known, although a connection between antitumor immune responses and irAEs has been suggested. In this study, we evaluated the development of ICIP in non-small cell lung cancer patients with prior radiotherapy, treated with immunotherapy in the second-line. Methods In this retrospective trial, we included patients treated with second-line immunotherapy at the National Cancer Institute in Mexico City from February 2015 to February 2018. Clinical, radiological and treatment variables were evaluated according to the presence of ICIP as defined by the Common Terminology Criteria for Adverse Events (4.0) in patients with or without a previous (≥months) history of radiotherapy. Results Among 101 NSCLC patients who received treatment with ICIs, 22 patients (21.8%) were diagnosed with ICIP, of which 73% (16/22) had a history of radiotherapy (OR 6.04, 95% CI 2.03-18.0, p < 0.001). Median progression free survival and overall survival were similar in patients who developed ICIP compared with those who did not, however, patients who presented grade ≥ 2 ICIP had an increased risk of mortality (HR 2.54, 95% CI 1.20-5.34, p = 0.014). Conclusion In this real-world cohort of NSCLC patients treated with ICI, the history of prior radiotherapy was associated with increased risk for ICIP development. Unlike other irAEs, grade ≥ 2 ICIP is an independent prognostic factor for decreased survival in NSCLC patients.
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Affiliation(s)
- Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, Mexico
| | - Roberto Sánchez
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, Mexico
| | | | | | | | - Rodrigo Catalán
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, Mexico
| | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Clinical Research and Biology Systems Department, Universidad el Bosque, Bogotá, Colombia
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, Mexico
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