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.
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,
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,
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,
While some immune-related adverse events can be defined and characterized by quantifiable laboratory values; for example,
or adrenal effects manifest as changes in thyroid-stimulating hormone,
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.
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,
Mariana Benegas Urteaga,
Hospital Clínic de Barcelona
Thoracic Complications of Precision Cancer Therapies: A Practical Guide for Radiologists in the New Era of Cancer Care.
Diagnosis and management of pulmonary toxicity associated with cancer immunotherapy.
Lancet Respir Med.
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.