Proposed clinical phases for the improvement of personalized treatment of checkpoint inhibitor–related pneumonitis

Zhou，Chengzhi1; Yang，Yilin1; Lin，Xinqing1; Fang，Nianxin2; Chen，Likun3; Jiang，Juhong1; Deng，Haiyi1; Deng，Yu1; Wan，Minghui1; Qiu，Guihuan1; Sun，Ni1; Wu，Di4; Long，Xiang5; Zhong，Changhao1; Xie，Xiaohong1; Xie，Zhanhong1; Liu，Ming1; Ouyang，Ming1; Qin，Yinyin1; Petrella，Francesco6,7; Fiorelli，Alfonso8; Bravaccini，Sara9; Kataoka，Yuki10; Watanabe，Satoshi11; Goto，Taichiro12; Solli，Piergiorgio13; Igai，Hitoshi14; Saito，Yuichi15; Tsoukalas，Nikolaos16; Nakada，Takeo17; Li，Shiyue1; Chen，Rongchang1,4

2022-07-20

10.3389/fimmu.2022.935779

Frontiers in Immunology   Impact Factor & Quartile

1664-3224

1664-3224

Background: Checkpoint inhibitor–related pneumonitis (CIP) is a lethal immune-related adverse event. However, the development process of CIP, which may provide insight into more effective management, has not been extensively examined. Methods: We conducted a multicenter retrospective analysis of 56 patients who developed CIP. Clinical characteristics, radiological features, histologic features, and laboratory tests were analyzed. After a comprehensive analysis, we proposed acute, subacute, and chronic phases of CIP and summarized each phase’s characteristics. Results: There were 51 patients in the acute phase, 22 in the subacute phase, and 11 in the chronic phase. The median interval time from the beginning of CIP to the different phases was calculated (acute phase: ≤4.9 weeks; subacute phase: 4.9~13.1 weeks; and chronic phase: ≥13.1 weeks). The symptoms relieved from the acute phase to the chronic phase, and the CIP grade and Performance Status score decreased (P<0.05). The main change in radiologic features was the absorption of the lesions, and 3 (3/11) patients in the chronic phase had persistent traction bronchiectasis. For histologic features, most patients had acute fibrinous pneumonitis in the acute phase (5/8), and most had organizing pneumonia in the subacute phase (5/6). Other histologic changes advanced over time, with the lesions entering a state of fibrosis. Moreover, the levels of interleukin-6, interleukin-10 and high-sensitivity C-reactive protein (hsCRP) increased in the acute phase and decreased as CIP progressed (IL-6: 17.9 vs. 9.8 vs. 5.7, P=0.018; IL-10: 4.6 vs 3.0 vs. 2.0, P=0.041; hsCRP: 88.2 vs. 19.4 vs. 14.4, P=0.005). Conclusions: The general development process of CIP can be divided into acute, subacute, and chronic phases, upon which a better management strategy might be based devised.

checkpoint inhibitor-related pneumonitis clinical phases glucocorticoids immune checkpoint inhibitor management

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English

Corresponding

Immunology

Immunology

WOS:000891345300001

FRONTIERS MEDIA SA

2-s2.0-85135831789

Scopus

1.State Key Laboratory of Respiratory Disease,National Clinical Research Centre for Respiratory Disease,First Affiliated Hospital,Guangzhou Institute of Respiratory Health,Guangzhou Medical University,Guangzhou,China
2.Affiliated Dongguan People’s Hospital,Dongguan Institute of Respiratory and Critical Care Medicine,Southern Medical University,Dongguan,China
3.Department of Medical Oncology,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat-sen University Cancer Center,Guangzhou,China
4.Shenzhen People’s Hospital,The Second Clinical Medical College of Jinan University,The First Affiliated Hospital,Southern University of Science and Technology,Shenzhen,China
5.Department of Respiratory Disease,Peking University Shenzhen Hospital,Shenzhen,China
6.Division of Thoracic Surgery,European Institute of Oncology,IRCCS,Milan,Italy
7.Department of Oncology and Hemato-oncology,University of Milan,Milan,Italy
8.Thoracic Surgery Unit,University of Campania Luigi Vanvitelli,Naples,Italy
9.IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori",Meldola,Italy
10.Department of Internal Medicine,Kyoto Min-Iren Asukai Hospital,Kyoto,Japan
11.Department of Respiratory Medicine and Infectious Diseases,Niigata University Graduate School of Medical and Dental Sciences,Niigata,Japan
12.Lung Cancer and Respiratory Disease Center,Yamanashi Central Hospital,Yamanashi,Japan
13.Division of Thoracic Surgery Lung Transplantation,IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy
14.Department of General Thoracic Surgery,Japanese Red Cross Maebashi Hospital,Maebashi,Japan
15.Department of Surgery,Teikyo University School of Medicine,Tokyo,Japan
16.Department of Oncology,401 General Military Hospital,Athens,Greece
17.Division of Thoracic Surgery,Department of Surgery,The Jikei University School of Medicine,Tokyo,Japan

Zhou，Chengzhi,Yang，Yilin,Lin，Xinqing,等. Proposed clinical phases for the improvement of personalized treatment of checkpoint inhibitor–related pneumonitis[J]. Frontiers in Immunology,2022,13.

Zhou，Chengzhi.,Yang，Yilin.,Lin，Xinqing.,Fang，Nianxin.,Chen，Likun.,...&Chen，Rongchang.(2022).Proposed clinical phases for the improvement of personalized treatment of checkpoint inhibitor–related pneumonitis.Frontiers in Immunology,13.

Zhou，Chengzhi,et al."Proposed clinical phases for the improvement of personalized treatment of checkpoint inhibitor–related pneumonitis".Frontiers in Immunology 13(2022).