Division of Pulmonology, Sultan Qaboos Comprehensive Cancer Care and R esearch Centre, Muscat, Oman.
Division of Oncology, Sultan Qaboos Comprehensive Cancer Care and R esearch Centre, Muscat, Oman.
Adv Respir Med. 2022;90(3):219-229. doi: 10.5603/ARM.84782.
Immune-checkpoint inhibitors (ICIs) have revolutionized treatment of solid malignancies, leading in some cases to durable responses. However, an unchecked immune response might lead to mild to severe immune-related adverse events (irAEs). Pulmonary toxicity, though often referred to as Immune checkpoint inhibitor-related pneumonitis (ICI-pneumonitis), covers a broad and overlapping spectrum of pulmonary manifestations and has been described in < 10% of patients receiving ICI either alone or in combination. However, the actual numbers in real-world populations are high, and are likely to increase as the therapeutic indications for ICIs continue to expand to include other malignancies. Drug withdrawal is the mainstay of treatment for ICI-pneumonitis. However, a good number of patients with higher grades of toxicity may need corticosteroids. Patients with refractory disease need additional immunosuppressive agents. In this brief review, we succinctly discuss the incidence, risk factors, mechanisms, clinical and radiologic manifestations, diagnosis and summarize the current management strategies of ICI-pneumonitis.
免疫检查点抑制剂（ICIs）已经彻底改变了实体恶性肿瘤的治疗方法，在某些情况下导致了持久的反应。然而，不受控制的免疫反应可能导致轻度至重度免疫相关不良事件（irAEs）。虽然肺部毒性通常被称为免疫检查点抑制剂相关肺炎（ICI-肺炎），但其涵盖了广泛且重叠的肺部表现谱，并且在单独或联合使用 ICI 的患者中<10%的患者中已经有描述。然而，在真实世界人群中的实际数字很高，并且随着 ICI 的治疗适应症继续扩大到包括其他恶性肿瘤，这一数字可能会增加。药物停药是 ICI-肺炎治疗的主要方法。然而，许多毒性较高的患者可能需要皮质类固醇。患有难治性疾病的患者需要额外的免疫抑制剂。在这篇简短的综述中，我们简明地讨论了 ICI-肺炎的发病率、危险因素、机制、临床和影像学表现、诊断，并总结了目前的管理策略。
