Tom 5, Nr 3 (2020)
Artykuły przeglądowe / Review articles
Opublikowany online: 2020-06-16

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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Pulmonary toxicities of immune checkpoint inhibitors

Magdalena Knetki-Wróblewska1, Joanna Domagała-Kulawik2
Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory 2020;5(3):141-146.

Streszczenie

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many malignancies. Toxicities of immunotherapy are variable, can involve almost every organ, therefore appropriate diagnosis and management of Immune Related Adverse Events (irAEs) is important. Immune-mediated pneumonitis is an uncommon, but potentially life-threatening toxicity of ICIs. Pre-existing lung disease, a history of lung radiotherapy, age > 70 years and male gender are suggested as the risk factors of pneumonitis. Dyspnoea, dry cough, fever and chest pain are typical symptoms. Diagnostic algorithms recommend radiological investigation with a chest computed tomography scan. Additional diagnostic procedures – such as pulse oximetry, spirometry, measurement of carbon monoxide diffusing capacity, bronchoscopy with BAL may be helpful. The therapeutic approach is determined by the intensity of the symptoms and CT findings. Corticosteroids and antibiotics are the drugs of choice. Hospitalisation is necessary in severe cases, and other forms of immunosuppression (infliximab, mycophenolate mofetil) may be considered. Continuation of immunotherapy can be considered with caution in patients with G1-2 toxicity, when clinical improvement was achieved and steroids were tapered.

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Referencje

  1. Brahmer JR, Lacchetti C, Schneider BJ, et al. National Comprehensive Cancer Network. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2018; 36(17): 1714–1768.
  2. Liu YH, Zang XY, Wang JC, et al. Diagnosis and Management of Immune Related Adverse Events (irAEs) in Cancer Immunotherapy. Biomed Pharmacother. 2019; 120: 109437.
  3. Wang DY, Salem JE, Cohen JV, et al. Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis. JAMA Oncol. 2018; 4(12): 1721–1728.
  4. Cadranel J, Canellas A, Matton L, et al. Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer. Eur Respir Rev. 2019; 28(153).
  5. Su Q, Zhu EC, Wu JB, et al. Risk of Pneumonitis and Pneumonia Associated With Immune Checkpoint Inhibitors for Solid Tumors: A Systematic Review and Meta-Analysis. Front Immunol. 2019; 10: 108.
  6. Nishino M, Giobbie-Hurder A, Hatabu H, et al. Incidence of Programmed Cell Death 1 Inhibitor-Related Pneumonitis in Patients With Advanced Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. 2016; 2(12): 1607–1616.
  7. Suresh K, Voong KR, Shankar B, et al. Pneumonitis in Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Immunotherapy: Incidence and Risk Factors. J Thorac Oncol. 2018; 13(12): 1930–1939.
  8. Cho JY, Kim J, Lee JS, et al. Characteristics, incidence, and risk factors of immune checkpoint inhibitor-related pneumonitis in patients with non-small cell lung cancer. Lung Cancer. 2018; 125: 150–156.
  9. Gray JE, Villegas A, Daniel D, et al. PACIFIC Investigators. Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. N Engl J Med. 2018; 379(24): 2342–2350.
  10. Fukihara J, Sakamoto K, Koyama J, et al. Prognostic Impact and Risk Factors of Immune-Related Pneumonitis in Patients With Non-Small-Cell Lung Cancer Who Received Programmed Death 1 Inhibitors. Clin Lung Cancer. 2019; 20(6): 442–450.e4.
  11. Fujimoto D, Morimoto T, Ito J, et al. A pilot trial of nivolumab treatment for advanced non-small cell lung cancer patients with mild idiopathic interstitial pneumonia. Lung Cancer. 2017; 111: 1–5.
  12. Yamaguchi T, Shimizu J, Hasegawa T, et al. Pre-existing pulmonary fibrosis is a risk factor for anti-PD-1-related pneumonitis in patients with non-small cell lung cancer: A retrospective analysis. Lung Cancer. 2018; 125: 212–217.
  13. Leonardi GC, Gainor JF, Altan M, et al. Safety of Programmed Death-1 Pathway Inhibitors Among Patients With Non-Small-Cell Lung Cancer and Preexisting Autoimmune Disorders. J Clin Oncol. 2018; 36(19): 1905–1912.
  14. Yoneshima Y, Tanaka K, Shiraishi Y, et al. Safety and efficacy of PD-1 inhibitors in non-small cell lung cancer patients positive for antinuclear antibodies. Lung Cancer. 2019; 130: 5–9.
  15. Ma Ke, Lu Y, Jiang S, et al. The Relative Risk and Incidence of Immune Checkpoint Inhibitors Related Pneumonitis in Patients With Advanced Cancer: A Meta-Analysis. Front Pharmacol. 2018; 9: 1430.
  16. Suresh K, Naidoo J, Lin CT, et al. Immune Checkpoint Immunotherapy for Non-Small Cell Lung Cancer: Benefits and Pulmonary Toxicities. Chest. 2018; 154(6): 1416–1423.
  17. Delaunay M, Cadranel J, Lusque A, et al. Immune-checkpoint inhibitors associated with interstitial lung disease in cancer patients. Eur Respir J. 2017; 50(2).
  18. Naidoo J, Wang X, Woo KM, et al. Pneumonitis in Patients Treated With Anti-Programmed Death-1/Programmed Death Ligand 1 Therapy. J Clin Oncol. 2017; 35(7): 709–717.
  19. Puzanov I, Diab A, Abdallah K, et al. Society for Immunotherapy of Cancer Toxicity Management Working Group. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J Immunother Cancer. 2017; 5(1): 95.
  20. Domagala-Kulawik J. The relevance of bronchoalveolar lavage fluid analysis for lung cancer patients. Expert Rev Respir Med. 2019; 14(3): 329–337.
  21. Suresh K, Naidoo J, Zhong Q, et al. The alveolar immune cell landscape is dysregulated in checkpoint inhibitor pneumonitis. J Clin Invest. 2019; 130: 4305–4315.
  22. Tanaka K, Yanagihara T, Ikematsu Y, et al. Detection of identical T cell clones in peritumoral pleural effusion and pneumonitis lesions in a cancer patient during immune-checkpoint blockade. Oncotarget. 2018; 9(55): 30587–30593.
  23. Martins F, Sykiotis GP, Maillard M, et al. New therapeutic perspectives to manage refractory immune checkpoint-related toxicities. Lancet Oncol. 2019; 20(1): e54–e64.
  24. Haanen J, Carbonnel F, Robert C. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017; 28: 119–142.
  25. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf.
  26. http://antybiotyki.edu.pl/rekomendacje/rekomendacje-diagnostyki-i-terapii-zakazen/.
  27. Caplan A, Fett N, Rosenbach M, et al. Prevention and management of glucocorticoid-induced side effects: A comprehensive review: Infectious complications and vaccination recommendations. J Am Acad Dermatol. 2017; 76(2): 191–198.
  28. O'Kane GM, Labbé C, Doherty MK, et al. Monitoring and Management of Immune-Related Adverse Events Associated With Programmed Cell Death Protein-1 Axis Inhibitors in Lung Cancer. Oncologist. 2017; 22(1): 70–80.



Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory