ORIGINAL RESEARCH ARTICLE
Clinical and Radiological Features and Treatment of Pulmonary Toxicity Associated with Using Immune Checkpoint Inhibitors in Cancer Treatment: A Single-Center Experience
Received Date : 14 Feb 2023
Accepted Date : 05 Apr 2023
Available Online : 04 May 2023
İvo GÖKMENa, Ali GÖKYERa, Fahri AKGÜLa, Erkan ÖZCANa, Aykut ALKANb, Nazan DEMİRc, İrfan ÇİÇİNa
aDivision of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Türkiye
bDepartment of Radiology, Trakya University Faculty of Medicine, Edirne, Türkiye
cClinic of Medical Oncology, Sultan I. Murat State Hospital, Edirne, Türkiye
Doi: 10.37047/jos.2023-95972 - Article's Language: EN
J Oncol Sci. 2023;9(2):62-71
ABSTRACT
Objective: Immune checkpoint inhibitor-related pneumonitis (ICI-P), as a rare, immune-related adverse event, is difficult to diagnose
and treat for clinicians because of its life-threatening adverse events and nonspecific clinical and laboratory findings. Material and
Methods: Patients with newly developed pulmonary infiltrates receiving ICI for cancer treatment were included in this study, and their images
were re-evaluated by a radiologist. Results: In this study, 32 (88.9%) male and four (11.3%) female patients with a median age of 62
years (range: 20-70 years) were enrolled, of whom 26 patients (72.3%) were diagnosed with non-small cell lung cancer. The most frequent
ICI-P-related symptom was cough (63.9%). The median time to the occurrence of ICI-P was 3.5 months (range: 0.3-20 months), and the median
number of cycles was four (range: 1-25). Ten patients needed hospitalization, 13 patients were found with permanent termination of ICI
therapy, and ICI-P recurred in six patients (16.7%). Other immunosuppressive treatments, such as using mycophenolate mofetil and infliximab,
were required in three steroid-refractory patients. No patient died due to uncontrolled ICI-P. Conclusion: In our study, consolidation
was the most common radiological finding of ICI-P, which may involve the contralateral side as well as the tumor margin, possibly mimicking
lymphangitic spread. Although ICI-P diagnosis is based on the exclusion of other differential diagnoses, it can mimic many other clinical
conditions. Empirical use of steroids should not be avoided if there is clinical suspicion because of the risk of mortality.
Keywords: Immunotherapy; pneumonia; adverse effects
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