Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease
BackgroundImmune checkpoint-induced pneumonitis (ICIP) is one of the most fatal adverse events caused by immune checkpoint inhibitors (ICI) and accounts for 35% of anti-PD-[L]1-related deaths. Risk factors including thoracic radiation and use of EGFR tyrosine kinase inhibitors have been identified a...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1283360/full |
| _version_ | 1797650847814909952 |
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| author | Emily Allen Godsfavour Umoru Veronica Ajewole Veronica Ajewole Eric Bernicker |
| author_facet | Emily Allen Godsfavour Umoru Veronica Ajewole Veronica Ajewole Eric Bernicker |
| author_sort | Emily Allen |
| collection | DOAJ |
| description | BackgroundImmune checkpoint-induced pneumonitis (ICIP) is one of the most fatal adverse events caused by immune checkpoint inhibitors (ICI) and accounts for 35% of anti-PD-[L]1-related deaths. Risk factors including thoracic radiation and use of EGFR tyrosine kinase inhibitors have been identified as contributors to ICIP development. However, there has been very limited information on obstructive pulmonary disease as a risk factor.ObjectiveThe purpose of this study is to evaluate the incidence and management of ICIP in a cohort of patients with pre-existing obstructive pulmonary disease.MethodsThis retrospective, descriptive study, includes data from 139 patients between January 1, 2017 and August 31, 2022. Patients included were adult patients 18 years or older, received at least 2 cycles of an immune checkpoint inhibitor, and had a history of an obstructive pulmonary disorder prior to administration. Patients were excluded if they had literature-established risk factors for pneumonitis.ResultsThe incidence of ICIP was 7.19% (10 out of 139 patients). From a management perspective, 90% of patients had immunotherapy held, 40% received oral steroids, and 70% received intravenous steroids at the time of ICIP identification. After receiving treatment for the initial episode of ICIP, 6 patients restarted immunotherapy and 3 (50%) subsequently experienced a recurrent episode. One patient experienced grade 4 ICIP event and subsequently died from respiratory failure attributed to ICIP.ConclusionThese findings indicate that a pre-existing history of an obstructive pulmonary disorder may be a risk factor for the development of ICIP and subsequent recurrence of ICIP when rechallenged. |
| first_indexed | 2024-03-11T16:07:37Z |
| format | Article |
| id | doaj.art-bc01a7175ade4fc99faabe216c762d67 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-11T16:07:37Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-bc01a7175ade4fc99faabe216c762d672023-10-25T00:01:02ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-10-011310.3389/fonc.2023.12833601283360Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary diseaseEmily Allen0Godsfavour Umoru1Veronica Ajewole2Veronica Ajewole3Eric Bernicker4Hematology/Oncology Department, Houston Methodist Hospital Texas Medical Center, Houston, TX, United StatesHematology/Oncology Department, Houston Methodist Hospital Texas Medical Center, Houston, TX, United StatesHematology/Oncology Department, Houston Methodist Hospital Texas Medical Center, Houston, TX, United StatesTexas State University College of Pharmacy and Health Sciences, Houston, TX, United StatesHematology/Oncology Department, Houston Methodist Hospital Texas Medical Center, Houston, TX, United StatesBackgroundImmune checkpoint-induced pneumonitis (ICIP) is one of the most fatal adverse events caused by immune checkpoint inhibitors (ICI) and accounts for 35% of anti-PD-[L]1-related deaths. Risk factors including thoracic radiation and use of EGFR tyrosine kinase inhibitors have been identified as contributors to ICIP development. However, there has been very limited information on obstructive pulmonary disease as a risk factor.ObjectiveThe purpose of this study is to evaluate the incidence and management of ICIP in a cohort of patients with pre-existing obstructive pulmonary disease.MethodsThis retrospective, descriptive study, includes data from 139 patients between January 1, 2017 and August 31, 2022. Patients included were adult patients 18 years or older, received at least 2 cycles of an immune checkpoint inhibitor, and had a history of an obstructive pulmonary disorder prior to administration. Patients were excluded if they had literature-established risk factors for pneumonitis.ResultsThe incidence of ICIP was 7.19% (10 out of 139 patients). From a management perspective, 90% of patients had immunotherapy held, 40% received oral steroids, and 70% received intravenous steroids at the time of ICIP identification. After receiving treatment for the initial episode of ICIP, 6 patients restarted immunotherapy and 3 (50%) subsequently experienced a recurrent episode. One patient experienced grade 4 ICIP event and subsequently died from respiratory failure attributed to ICIP.ConclusionThese findings indicate that a pre-existing history of an obstructive pulmonary disorder may be a risk factor for the development of ICIP and subsequent recurrence of ICIP when rechallenged.https://www.frontiersin.org/articles/10.3389/fonc.2023.1283360/fullimmune checkpoint-induced pneumonitisimmunotherapypulmonary diseaseimmune checkpoint inhibitorsPD-1/PD-L1 inhibitors |
| spellingShingle | Emily Allen Godsfavour Umoru Veronica Ajewole Veronica Ajewole Eric Bernicker Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease Frontiers in Oncology immune checkpoint-induced pneumonitis immunotherapy pulmonary disease immune checkpoint inhibitors PD-1/PD-L1 inhibitors |
| title | Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease |
| title_full | Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease |
| title_fullStr | Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease |
| title_full_unstemmed | Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease |
| title_short | Incidence and outcome of immune checkpoint-induced pneumonitis in oncology patients with history of pulmonary disease |
| title_sort | incidence and outcome of immune checkpoint induced pneumonitis in oncology patients with history of pulmonary disease |
| topic | immune checkpoint-induced pneumonitis immunotherapy pulmonary disease immune checkpoint inhibitors PD-1/PD-L1 inhibitors |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1283360/full |
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