Xu Yan, Chen Ruxuan, Pan Ruili, Gao Xiaoxing, Huang Hui, Wang Mengzhao
Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Chin Med J Pulm Crit Care Med. 2025 Mar 8;3(1):29-40. doi: 10.1016/j.pccm.2024.12.001. eCollection 2025 Mar.
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment landscape for various malignancies by demonstrating exceptional antitumor effects and significant improvement in patient survival. Despite their overt therapeutic advantages, ICIs also induce immune-related adverse events (irAEs). Of these, checkpoint inhibitor pneumonitis (CIP) represents a prominent manifestation of pulmonary toxicity following ICI therapy, with incidence rates ranging from 2.7 % to 20.0 %. Notably, a substantial proportion of CIP cases show severe manifestations, often leading to life-threatening complications, which emphasizes its clinical significance. Understanding the risk factors and potential pathogenetic mechanisms of CIP, combined with vigilant monitoring during immunotherapy, is pivotal for early detection and management of this condition. Proactive strategies for the timely identification, accurate diagnosis, and effective management of CIP are essential to optimize patient outcomes. However, several challenges persist in CIP management, including management of severe and refractory cases, determining the timing of ICI rechallenge after CIP, management of long-term chronic CIP, and mitigating secondary infections. In order to manage this potentially life-threatening irAE effectively, it is urgent to establish multi-disciplinary treatment (MDT) management, precision CIP management, and practical surveillance systems for CIP monitoring, diagnosis, and management and to call for prospective multi-center clinical trials.
免疫检查点抑制剂（ICIs）通过展现出卓越的抗肿瘤效果以及显著提高患者生存率，彻底改变了各种恶性肿瘤的治疗格局。尽管ICIs具有明显的治疗优势，但它们也会引发免疫相关不良事件（irAEs）。其中，检查点抑制剂肺炎（CIP）是ICI治疗后肺部毒性的一种突出表现，发病率在2.7%至20.0%之间。值得注意的是，相当一部分CIP病例表现出严重症状，常常导致危及生命的并发症，这凸显了其临床重要性。了解CIP的危险因素和潜在发病机制，并在免疫治疗期间进行密切监测，对于该病症的早期发现和管理至关重要。采取积极主动的策略及时识别、准确诊断和有效管理CIP，对于优化患者预后至关重要。然而，CIP管理仍存在一些挑战，包括严重和难治性病例的管理、确定CIP后ICI再次治疗的时机、长期慢性CIP的管理以及减轻继发感染。为了有效管理这种潜在危及生命的irAE，迫切需要建立多学科治疗（MDT）管理、精准CIP管理以及用于CIP监测、诊断和管理的实用监测系统，并呼吁开展前瞻性多中心临床试验。
