Learning objectives
To know thoracic complications related to immune-checkpoint inhibitors therapy,
termed immune-related adverse events (irAEs).
To describe radiologic manifestations of the irAEs in the lung.
To provide an easy and schematic diagnostic approach to irAEs with a combination of imaging and clinical features in a multidisciplinary working.
Background
Immunotherapy and irAEs
Immunotherapy has emerged as a promising treatment option for advanced cancer and is now considered standard of care for multiple cancer.
Immune checkpoint inhibitors have shown remarkable beneficial effects in several cancer types,
including lung cancer,
kidney cancer,
melanoma,
head-and-neck cancer,
bladder cancer,
lymphoma and Merkel cell cancer.
Currently approved drugs in this class include:
- CTLA-4 inhibitor: Ipilimumab
- PD-1 inhibitors: pembrolizumab and nivolumab
- PD-L1 inhibitors: durvalumab,
atezolizumab,
and avelumab.
The anticancer activity of immune checkpoint inhibitors therapy is due...
Findings and procedure details
Diagnostic approach to thoracic irAEs
The diagnostic approach to irAEs requires multidisciplinary effort by pulmonologists,
medical oncologists,
and radiologists.
Clinical manifestations
While some immune-related adverse events can be defined and characterized by quantifiable laboratory values; for example,
immune thyroid,
pituitary,
or adrenal effects manifest as changes in thyroid-stimulating hormone,
free thyroxine,
adrenocorticotropin,
and cortisol; immune-related pulmonary toxicities clinically manifest with relatively non-specific features.
Clinical manifestations might be quite difficult to distinguish from disease-related complaints or other treatment-related complications such as infection or anaemia.
Symptoms might...
Conclusion
The role of the radiologist in the diagnostic approach and monitoring to thoracic immune-related adverse events is essential.
HRCT is the preferred diagnostic study when pulmonary immune-related toxicity is suspected.
Optimal patient care during immunotherapy requires multidisciplinary effort by pulmonologists,
medical oncologists,
and radiologists.
References
Nishino M,
Hatabu H,
Sholl LM,
Ramaiya NH.
Thoracic Complications of Precision Cancer Therapies: A Practical Guide for Radiologists in the New Era of Cancer Care.
Radiographics.
2017 Sep-Oct;37(5):1371-1387.
Rashdan S,
Minna JD,
Gerber DE.
Diagnosis and management of pulmonary toxicity associated with cancer immunotherapy.
Lancet Respir Med.
2018 Jun;6(6):472-478.
Nishino M,
Giobbie-Hurder A,
Hatabu H,
Ramaiya NH,
Hodi FS.
Incidence of programmed cell death 1 inhibitor–related pneumonitis in patients with advanced cancer: a systematic review and meta-analysis.
JAMA Oncol 2016;2(12):1607–1616.
Nishino M,
Ramaiya NH,...