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Original Article
- Lung cancer
- Sequential Treatment with an Immune Checkpoint Inhibitor Followed by a Small-Molecule Targeted Agent Increases Drug-Induced Pneumonitis
- Jongheon Jung, Hyae Young Kim, Dong-Gil Kim, Seog Yun Park, A Ra Ko, Ji-Youn Han, Heung Tae Kim, Jin Soo Lee, Youngjoo Lee
- Cancer Res Treat. 2021;53(1):77-86. Published online August 6, 2020
- DOI: https://doi.org/10.4143/crt.2020.543
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Abstract
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Supplementary Material
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ePub - Purpose
Immune checkpoint inhibitors (ICI) and targeted small-molecule drugs are mainstay elements of lung cancer chemotherapy. However, they are associated with development of pneumonitis, a rare, but potentially life-threatening event. We analyzed lung cancer patients treated with ICI to evaluate the effect of sequential therapeutic administration on the incidence of pneumonitis.
Materials and Methods
In this retrospective study, 242 patients were included. Serial radiologic findings taken during and immediately after ICI treatment were reviewed. Factors that increased pneumonitis and the relationship between peri-ICI chemotherapy and the development of pneumonitis were evaluated.
Results
Pneumonitis developed in 23 patients (9.5%); severe pneumonitis (grade ≥ 3) occurred in 13 of 23 patients (56%); pneumonitis-related death occurred in six. High-dose thoracic radiation (≥ 6,000 cGy) revealed a tendency toward high risk of pneumonitis (odds ratio, 2.642; 95% confidence interval, 0.932 to 7.490; p=0.068). Among 149 patients followed for ≥ 8 weeks after the final ICI dose, more patients who received targeted agents within 8-weeks post-ICI experienced pneumonitis (3/16, 18.8%) compared with patients who received cytotoxic agents (4/54, 7.4%) or no chemotherapy (4/79, 5.1%) (p=0.162). Targeted therapy was associated with earlier-onset pneumonitis than treatment with cytotoxic agents (35 vs. 62 days post-ICI, p=0.007); the resulting pneumonitis was more severe (grade ≥ 3, 100% vs. 0%, p=0.031).
Conclusion
Sequential administration of small-molecule targeted agents immediately after ICI may increase the risk of severe pneumonitis. The sequence of chemotherapy regimens that include ICI and targeted agents should be carefully planned to reduce the risk of pneumonitis in lung cancer patients. -
Citations
Citations to this article as recorded by
- Toxicities associated with sequential or combined use of immune checkpoint inhibitors and small targeted therapies in non-small cell lung cancer: A critical review of the literature
Anne-Laure Désage, Michael Duruisseaux, Claire Lafitte, Sophie Bayle-Bleuez, Christos Chouaid, Pierre Fournel, Thomas Pierret
Cancer Treatment Reviews.2024; 129: 102805. CrossRef - Deep learning for predicting the risk of immune checkpoint inhibitor-related pneumonitis in lung cancer
M. Cheng, R. Lin, N. Bai, Y. Zhang, H. Wang, M. Guo, X. Duan, J. Zheng, Z. Qiu, Y. Zhao
Clinical Radiology.2023; 78(5): e377. CrossRef - Evaluating Pneumonitis Incidence in Patients with Non–small Cell Lung Cancer Treated with Immunotherapy and/or Chemotherapy Using Real-world and Clinical Trial Data
Qi Liu, Chenan Zhang, Yue Huang, Ruihao Huang, Shiew-Mei Huang, Erin Larkins, Liza Stapleford, Donna R. Rivera, Paul G. Kluetz, Shenggang Wang, Hao Zhu, James Weese, Elizabeth Cromartie, Mahder Teka, Sheetal Walters, Frank Wolf, Thomas D. Brown
Cancer Research Communications.2023; 3(2): 258. CrossRef - Pulmonary toxicity in driver gene positive non-small cell lung cancer therapy
Yi-Pu Zhao, Yong Long
Current Medical Research and Opinion.2022; 38(8): 1369. CrossRef - Immune checkpoint inhibitor-related pneumonitis in non-small cell lung cancer: A review
Yuxuan Hao, Xiaoye Zhang, Li Yu
Frontiers in Oncology.2022;[Epub] CrossRef - Improving Time-to-Treatment for Advanced Non-Small Cell Lung Cancer Patients through Faster Single Gene EGFR Testing Using the Idylla™ EGFR Testing Platform
Norbert Banyi, Deepu Alex, Curtis Hughesman, Kelly McNeil, Diana N. Ionescu, Carmen Ma, Stephen Yip, Barbara Melosky
Current Oncology.2022; 29(10): 7900. CrossRef - Sequential or combined immune checkpoint inhibitors and targeted therapy: Navigating uncharted waters
K. El Husseini, M. Wislez
Respiratory Medicine and Research.2021; 79: 100820. CrossRef - Multiple drugs
Reactions Weekly.2021; 1863(1): 255. CrossRef - Deep learning model enables the discovery of a novel immunotherapeutic agent regulating the kynurenine pathway
Jeong Hun Kim, Won Suk Lee, Hye Jin Lee, Hannah Yang, Seung Joon Lee, So Jung Kong, Soyeon Je, Hyun-Jin Yang, Jongsun Jung, Jaekyung Cheon, Beodeul Kang, Hong Jae Chon, Chan Kim
OncoImmunology.2021;[Epub] CrossRef
- Toxicities associated with sequential or combined use of immune checkpoint inhibitors and small targeted therapies in non-small cell lung cancer: A critical review of the literature
- 7,900 View
- 201 Download
- 9 Web of Science
- 9 Crossref
Case Report
- A Case of Organizing Pneumonia Associated with Rituximab
- Chi Hoon Maeng, Sang Ouk Chin, Byung Hyuk Yang, Si-young Kim, Hwi-Joong Youn, Kyung Sam Cho, Sun Kyung Baek, Sun Lee
- Cancer Res Treat. 2007;39(2):88-91. Published online June 30, 2007
- DOI: https://doi.org/10.4143/crt.2007.39.2.88
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Abstract
PDFPubReaderePub
Rituximab is a human/murine chimeric anti-CD20 monoclonal antibody used to treat CD20-positive B-cell non-Hodgkin's lymphoma (NHL). Although most of the adverse effects associated with rituximab are usually reversible and temporary infusion-related reactions, including fever, chills, flushing and skin reactions, there are several reports of pulmonary events after long-term administration of rituximab. We present a case of asymptomatic nodular organizing pneumonia occurring during rituximab-based chemotherapy in a patient with non-Hodgkin's lymphoma.
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Citations
Citations to this article as recorded by- Ocrelizumab-associated cryptogenic organizing pneumonia in multiple sclerosis: Two case reports and comprehensive literature review
Alessandro Gans, Elena Pinuccia Verrengia, Elisabetta Ricchiuti, Serena Leva, Simona Brajkovic, Daniele Colombo, Antonino Mazzone, Alessandro Prelle
Multiple Sclerosis Journal.2024;[Epub] CrossRef - Rituximab for steroid-resistant organising pneumonia in a woman with rheumatoid arthritis
Christine Elizabeth Loftis, Emilia Dulgheru, Adolfo Kaplan
BMJ Case Reports.2022; 15(11): e249912. CrossRef - Organizing pneumonia associated with T‐cell lymphoma
Chrystal Chan, Andrei D. Fagarasanu, Andre Reid, Daniel C. Sadowski, Ashley‐Mae E. Gillson
Respirology Case Reports.2020;[Epub] CrossRef - Non-infectious pulmonary toxicity of rituximab: a systematic review
A. V. Hadjinicolaou, M. K. Nisar, H. Parfrey, E. R. Chilvers, A. J. K. Ostor
Rheumatology.2012; 51(4): 653. CrossRef - Toxic Epidermal Necrolysis after Rituximab Therapy for Immune Thrombocytopenic Purpura
Soo-Young Bae, Yeo-Kyeoung Kim, Joo-Young Yoon, Sung-Ji Lee, Dae Eun Kim, Sung Yoon Rew, Seung Dok Hong, Dae-Ho Jo, Joon-Il Hwang, Woo-Kyun Bae, Hyun-Jeong Shim, Jae-Sook Ahn, Deok-Hwan Yang, Sang-Hee Cho, Je-Jung Lee, Ik-Joo Chung, Hyeoung-Joon Kim
The Korean Journal of Hematology.2009; 44(2): 108. CrossRef
- Ocrelizumab-associated cryptogenic organizing pneumonia in multiple sclerosis: Two case reports and comprehensive literature review
- 8,859 View
- 82 Download
- 5 Crossref
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