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Management of pulmonary toxicity associated with immune checkpoint inhibitors

Myriam Delaunay, Grégoire Prévot, Samia Collot, Laurent Guilleminault, Alain Didier, Julien Mazières
European Respiratory Review 2019 28: 190012; DOI: 10.1183/16000617.0012-2019
Myriam Delaunay
Respiratory Disease Dept, Larrey Hospital, University Hospital of Toulouse, Paul Sabatier University, Toulouse, France
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Grégoire Prévot
Respiratory Disease Dept, Larrey Hospital, University Hospital of Toulouse, Paul Sabatier University, Toulouse, France
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Samia Collot
Radiology Dept, Rangueil Hospital, University Hospital of Toulouse, Toulouse, France
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Laurent Guilleminault
Respiratory Disease Dept, Larrey Hospital, University Hospital of Toulouse, Paul Sabatier University, Toulouse, France
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Alain Didier
Respiratory Disease Dept, Larrey Hospital, University Hospital of Toulouse, Paul Sabatier University, Toulouse, France
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Julien Mazières
Respiratory Disease Dept, Larrey Hospital, University Hospital of Toulouse, Paul Sabatier University, Toulouse, France
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  • For correspondence: mazieres.j@chu-toulouse.fr
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  • FIGURE 1
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    FIGURE 1

    Main respiratory toxicities linked to immunotherapy.

  • FIGURE 2
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    FIGURE 2

    Comparison between three studies: severity grade and radiological patterns. OP: organising pneumoniae; HSP: hypersensitivity pneumonitis; NSIP: non-specific interstitial pneumoniae; GGO: ground-glass opacities; ARDS: acute respiratory distress syndrome. #: Common Terminology Criteria for Adverse Events 4:0.

  • FIGURE 3
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    FIGURE 3

    Suggested “decision tree” for interstitial lung disease induced by immune-checkpoint inhibitors (ICI) treatment. CT: computed tomography. #: progressive cancer lesions, infection, pulmonary embolism or heart failure.

  • FIGURE 4
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    FIGURE 4

    Suggested management according to severity grade. Grade 1: asymptomatic, clinical or diagnostic observation only; intervention not indicated; Grade 2: symptomatic, medical intervention indicated; limiting instrumental activities of daily living; Grade 3: severe symptoms; limiting self-care activities of daily living, oxygen indicated; Grade 4: life-threatening respiratory compromise; urgent intervention indicated (e.g. tracheotomy or intubation). #: a disorder characterised by inflammation focally or diffusely affecting the lung parenchyma.

  • FIGURE 5
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    FIGURE 5

    Interstitial lung disease induced by immune-checkpoint inhibitors improvement after treatment. OP: organising pneumoniae; HSP: hypersensitivity pneumonitis.

Tables

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  • TABLE 1

    Comparison between the three studies

    StudyNaidoo et al. [7]Nishino et al. [8]Delaunay et al. [6]
    Cases n432064
    Histology26 Melanoma10 Melanoma13 Melanoma
    9 NSCLC4 NSCLC48 NSCLC
    4 Haematological malignancies6 Lymphoma1 Lymphoma
    1 Bladder carcinoma2 Head and neck carcinoma
    1 Breast carcinoma
    1 Pancreatic carcinoma
    1 Head and neck carcinoma
    Incidence5%11.8%3.5%
    Time to pneumonitis onset2.8 months (9 days to 19.2 months)2.6 months (0.5–11.5)2.3 months (0.2–27.4)

    Data presented as median (range), unless otherwise stated. NSCLC: nonsmall cell lung cancer.

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    Management of pulmonary toxicity associated with immune checkpoint inhibitors
    Myriam Delaunay, Grégoire Prévot, Samia Collot, Laurent Guilleminault, Alain Didier, Julien Mazières
    European Respiratory Review Dec 2019, 28 (154) 190012; DOI: 10.1183/16000617.0012-2019

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    Management of pulmonary toxicity associated with immune checkpoint inhibitors
    Myriam Delaunay, Grégoire Prévot, Samia Collot, Laurent Guilleminault, Alain Didier, Julien Mazières
    European Respiratory Review Dec 2019, 28 (154) 190012; DOI: 10.1183/16000617.0012-2019
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    • Article
      • Abstract
      • Abstract
      • Introduction
      • What is the incidence of pulmonary toxicity associated with ICI treatment?
      • Can we forecast or predict pulmonary toxicity?
      • How to diagnose ILD associated with ICI treatment?
      • How to treat ILD-ICI
      • Can we re-challenge patients with immunotherapy following lung toxicity?
      • Other pulmonary toxicities
      • What is the impact of immune-related adverse events on patient outcomes?
      • Organisation
      • Conclusion
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
    • PDF

    Subjects

    • Pulmonary pharmacology and therapeutics
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