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      Immune checkpoint inhibitor-related chronic pneumonitis: a case report and literature review

      1 , 2 , 2 , 2 , 2 , 2 , 2 , 1 , 2
      Immunotherapy
      Informa UK Limited

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          Abstract

          Immune checkpoint inhibitor (ICI)-related chronic pneumonitis is rare. Limited information is available on the characteristics of this condition. Herein, we present the case of a 54-year-old man with recurrent severe ICI-related pneumonitis. The patient developed fever and dyspnea during both episodes of pneumonitis. He had been previously diagnosed with gastric signet ring cell carcinoma and was undergoing treatment with an anti-PD-1 combination chemotherapy regimen. We reviewed previous case reports of ICI-related pneumonitis according to the primary cancer, time of onset in relation to ICI therapy and chest imaging findings. ICI-related pneumonitis can progress to chronic pneumonitis. Repeated computed tomography imaging showing lung changes in the same location may help to make the diagnosis.

          Abstract

          Plain language summary

          Immune checkpoint inhibitors (ICIs) are a type of medicine that helps fight stomach cancer but sometimes they can cause problems with the lungs. This case report is about a man who had two bad lung incidents after taking ICI medicine. He had trouble breathing and fever both times. Other people have had similar problems with their lungs after being given ICI treatment. We compared chest pictures of the patient receiving ICI treatment over time and saw changes in the same spot meaning there might be a long-term problem with the lungs. We need to do more research to figure out how to treat this problem better.

          Abstract

          Tweetable abstract

          Repeated computed tomography imaging was useful for diagnosing recurrent immune checkpoint inhibitor-related pneumonitis in a man with gastric cancer.

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          Most cited references34

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          Blockade of programmed death 1 (PD-1), an inhibitory receptor expressed by T cells, can overcome immune resistance. We assessed the antitumor activity and safety of BMS-936558, an antibody that specifically blocks PD-1. We enrolled patients with advanced melanoma, non-small-cell lung cancer, castration-resistant prostate cancer, or renal-cell or colorectal cancer to receive anti-PD-1 antibody at a dose of 0.1 to 10.0 mg per kilogram of body weight every 2 weeks. Response was assessed after each 8-week treatment cycle. Patients received up to 12 cycles until disease progression or a complete response occurred. A total of 296 patients received treatment through February 24, 2012. Grade 3 or 4 drug-related adverse events occurred in 14% of patients; there were three deaths from pulmonary toxicity. No maximum tolerated dose was defined. Adverse events consistent with immune-related causes were observed. Among 236 patients in whom response could be evaluated, objective responses (complete or partial responses) were observed in those with non-small-cell lung cancer, melanoma, or renal-cell cancer. Cumulative response rates (all doses) were 18% among patients with non-small-cell lung cancer (14 of 76 patients), 28% among patients with melanoma (26 of 94 patients), and 27% among patients with renal-cell cancer (9 of 33 patients). Responses were durable; 20 of 31 responses lasted 1 year or more in patients with 1 year or more of follow-up. To assess the role of intratumoral PD-1 ligand (PD-L1) expression in the modulation of the PD-1-PD-L1 pathway, immunohistochemical analysis was performed on pretreatment tumor specimens obtained from 42 patients. Of 17 patients with PD-L1-negative tumors, none had an objective response; 9 of 25 patients (36%) with PD-L1-positive tumors had an objective response (P=0.006). Anti-PD-1 antibody produced objective responses in approximately one in four to one in five patients with non-small-cell lung cancer, melanoma, or renal-cell cancer; the adverse-event profile does not appear to preclude its use. Preliminary data suggest a relationship between PD-L1 expression on tumor cells and objective response. (Funded by Bristol-Myers Squibb and others; ClinicalTrials.gov number, NCT00730639.).
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            Immune-Related Adverse Events Associated with Immune Checkpoint Blockade

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              Cancer immunotherapy comes of age.

              Activating the immune system for therapeutic benefit in cancer has long been a goal in immunology and oncology. After decades of disappointment, the tide has finally changed due to the success of recent proof-of-concept clinical trials. Most notable has been the ability of the anti-CTLA4 antibody, ipilimumab, to achieve a significant increase in survival for patients with metastatic melanoma, for which conventional therapies have failed. In the context of advances in the understanding of how tolerance, immunity and immunosuppression regulate antitumour immune responses together with the advent of targeted therapies, these successes suggest that active immunotherapy represents a path to obtain a durable and long-lasting response in cancer patients.
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                Author and article information

                Contributors
                Journal
                Immunotherapy
                Immunotherapy
                Informa UK Limited
                1750-743X
                1750-7448
                October 2023
                October 2023
                : 15
                : 14
                : 1117-1123
                Affiliations
                [1 ]Graduate School, Hebei North University, Zhangjiakou City, Hebei Province, 075000, China
                [2 ]Department of Respiratory & Critical Care Clinical Medicine, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, 075000, China
                Article
                10.2217/imt-2023-0006
                fed67695-da4e-400b-9df3-2827003129df
                © 2023
                History

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