Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case report
Abstract Background Nintedanib is a tyrosine kinase inhibitor that efficiently slows the progression of idiopathic pulmonary fibrosis (IPF) and has an acceptable tolerability profile. In contrast, immune checkpoint inhibitors (ICIs) such as programmed death 1 and programmed death ligand 1 inhibitors...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12890-019-0920-9 |
| _version_ | 1818450188358909952 |
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| author | Hideaki Yamakawa Tomohiro Oba Hiroki Ohta Yuta Tsukahara Gen Kida Emiri Tsumiyama Tomotaka Nishizawa Rie Kawabe Shintaro Sato Keiichi Akasaka Masako Amano Kazuyoshi Kuwano Hidekazu Matsushima |
| author_facet | Hideaki Yamakawa Tomohiro Oba Hiroki Ohta Yuta Tsukahara Gen Kida Emiri Tsumiyama Tomotaka Nishizawa Rie Kawabe Shintaro Sato Keiichi Akasaka Masako Amano Kazuyoshi Kuwano Hidekazu Matsushima |
| author_sort | Hideaki Yamakawa |
| collection | DOAJ |
| description | Abstract Background Nintedanib is a tyrosine kinase inhibitor that efficiently slows the progression of idiopathic pulmonary fibrosis (IPF) and has an acceptable tolerability profile. In contrast, immune checkpoint inhibitors (ICIs) such as programmed death 1 and programmed death ligand 1 inhibitors have shown clinical activity and marked efficacy in the treatment of non-small cell lung cancer. However, it is unclear whether nintedanib reduces the risk of ICI-induced pneumonitis in IPF. Case presentation A 78-year-old man with squamous cell lung carcinoma in IPF underwent second-line treatment with pembrolizumab. He was diagnosed as having pembrolizumab-induced pneumonitis after two cycles. He was administered prednisolone (PSL) and then improved immediately. Thereafter, his lung cancer lesion enlarged despite treatment with TS-1. Atezolizumab was then administered as 4th-line chemotherapy, but he immediately developed atezolizumab-induced pneumonitis after 1 cycle. The re-escalated dosage of PSL improved the pneumonitis, and then nintedanib was started as additional therapy. Under careful observation with nintedanib, atezolizumab was re-administered on day 1 of an every-21-day cycle. After three cycles, it remained stable without exacerbation of drug-induced pneumonitis. Conclusion This case indicates the possibility that the addition of nintedanib to ICI therapy might prevent drug-induced pneumonitis or acute exacerbation of IPF. However, whether anti-fibrotic agents such as nintedanib are actually effective in preventing ICI-induced pneumonitis in ILD remains unknown and additional research is greatly needed to identify effective therapies for ILD combined with lung cancer. |
| first_indexed | 2024-12-14T20:47:20Z |
| format | Article |
| id | doaj.art-9b92868329c5455092d3628e31e70301 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-14T20:47:20Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-9b92868329c5455092d3628e31e703012022-12-21T22:47:59ZengBMCBMC Pulmonary Medicine1471-24662019-08-011911510.1186/s12890-019-0920-9Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case reportHideaki Yamakawa0Tomohiro Oba1Hiroki Ohta2Yuta Tsukahara3Gen Kida4Emiri Tsumiyama5Tomotaka Nishizawa6Rie Kawabe7Shintaro Sato8Keiichi Akasaka9Masako Amano10Kazuyoshi Kuwano11Hidekazu Matsushima12Department of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalDepartment of Respiratory Medicine, Tokyo Jikei University HospitalDepartment of Respiratory Medicine, Saitama Red Cross HospitalAbstract Background Nintedanib is a tyrosine kinase inhibitor that efficiently slows the progression of idiopathic pulmonary fibrosis (IPF) and has an acceptable tolerability profile. In contrast, immune checkpoint inhibitors (ICIs) such as programmed death 1 and programmed death ligand 1 inhibitors have shown clinical activity and marked efficacy in the treatment of non-small cell lung cancer. However, it is unclear whether nintedanib reduces the risk of ICI-induced pneumonitis in IPF. Case presentation A 78-year-old man with squamous cell lung carcinoma in IPF underwent second-line treatment with pembrolizumab. He was diagnosed as having pembrolizumab-induced pneumonitis after two cycles. He was administered prednisolone (PSL) and then improved immediately. Thereafter, his lung cancer lesion enlarged despite treatment with TS-1. Atezolizumab was then administered as 4th-line chemotherapy, but he immediately developed atezolizumab-induced pneumonitis after 1 cycle. The re-escalated dosage of PSL improved the pneumonitis, and then nintedanib was started as additional therapy. Under careful observation with nintedanib, atezolizumab was re-administered on day 1 of an every-21-day cycle. After three cycles, it remained stable without exacerbation of drug-induced pneumonitis. Conclusion This case indicates the possibility that the addition of nintedanib to ICI therapy might prevent drug-induced pneumonitis or acute exacerbation of IPF. However, whether anti-fibrotic agents such as nintedanib are actually effective in preventing ICI-induced pneumonitis in ILD remains unknown and additional research is greatly needed to identify effective therapies for ILD combined with lung cancer.http://link.springer.com/article/10.1186/s12890-019-0920-9NintedanibImmune checkpoint inhibitorsDrug-induced pneumonitis |
| spellingShingle | Hideaki Yamakawa Tomohiro Oba Hiroki Ohta Yuta Tsukahara Gen Kida Emiri Tsumiyama Tomotaka Nishizawa Rie Kawabe Shintaro Sato Keiichi Akasaka Masako Amano Kazuyoshi Kuwano Hidekazu Matsushima Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case report BMC Pulmonary Medicine Nintedanib Immune checkpoint inhibitors Drug-induced pneumonitis |
| title | Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case report |
| title_full | Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case report |
| title_fullStr | Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case report |
| title_full_unstemmed | Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case report |
| title_short | Nintedanib allows retreatment with atezolizumab of combined non-small cell lung cancer/idiopathic pulmonary fibrosis after atezolizumab-induced pneumonitis: a case report |
| title_sort | nintedanib allows retreatment with atezolizumab of combined non small cell lung cancer idiopathic pulmonary fibrosis after atezolizumab induced pneumonitis a case report |
| topic | Nintedanib Immune checkpoint inhibitors Drug-induced pneumonitis |
| url | http://link.springer.com/article/10.1186/s12890-019-0920-9 |
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