Frontiers in Immunology (Jul 2022)
Proposed clinical phases for the improvement of personalized treatment of checkpoint inhibitor–related pneumonitis
- Chengzhi Zhou,
- Yilin Yang,
- Xinqing Lin,
- Nianxin Fang,
- Likun Chen,
- Juhong Jiang,
- Haiyi Deng,
- Yu Deng,
- Minghui Wan,
- Guihuan Qiu,
- Ni Sun,
- Di Wu,
- Xiang Long,
- Changhao Zhong,
- Xiaohong Xie,
- Zhanhong Xie,
- Ming Liu,
- Ming Ouyang,
- Yinyin Qin,
- Francesco Petrella,
- Francesco Petrella,
- Alfonso Fiorelli,
- Sara Bravaccini,
- Yuki Kataoka,
- Satoshi Watanabe,
- Taichiro Goto,
- Piergiorgio Solli,
- Hitoshi Igai,
- Yuichi Saito,
- Nikolaos Tsoukalas,
- Takeo Nakada,
- Shiyue Li,
- Rongchang Chen,
- Rongchang Chen
Affiliations
- Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Yilin Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Nianxin Fang
- Affiliated Dongguan People’s Hospital, Dongguan Institute of Respiratory and Critical Care Medicine, Southern Medical University, Dongguan, China
- Likun Chen
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Juhong Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Haiyi Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Yu Deng
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Minghui Wan
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Guihuan Qiu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Ni Sun
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Di Wu
- Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Xiang Long
- Department of Respiratory Disease, Peking University Shenzhen Hospital, Shenzhen, China
- Changhao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Xiaohong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Zhanhong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Ming Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Ming Ouyang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Yinyin Qin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy
- Francesco Petrella
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
- Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Yuki Kataoka
- 0Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Satoshi Watanabe
- 1Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Taichiro Goto
- 2Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
- Piergiorgio Solli
- 3Division of Thoracic Surgery & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Hitoshi Igai
- 4Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
- Yuichi Saito
- 5Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Nikolaos Tsoukalas
- 6Department of Oncology, 401 General Military Hospital, Athens, Greece
- Takeo Nakada
- 7Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
- Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, First Affiliated Hospital, Guangzhou Institute of Respiratory Health, Guangzhou Medical University, Guangzhou, China
- Rongchang Chen
- Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- DOI
- https://doi.org/10.3389/fimmu.2022.935779
- Journal volume & issue
-
Vol. 13
Abstract
BackgroundCheckpoint inhibitor–related pneumonitis (CIP) is a lethal immune-related adverse event. However, the development process of CIP, which may provide insight into more effective management, has not been extensively examined.MethodsWe conducted a multicenter retrospective analysis of 56 patients who developed CIP. Clinical characteristics, radiological features, histologic features, and laboratory tests were analyzed. After a comprehensive analysis, we proposed acute, subacute, and chronic phases of CIP and summarized each phase’s characteristics.ResultsThere were 51 patients in the acute phase, 22 in the subacute phase, and 11 in the chronic phase. The median interval time from the beginning of CIP to the different phases was calculated (acute phase: ≤4.9 weeks; subacute phase: 4.9~13.1 weeks; and chronic phase: ≥13.1 weeks). The symptoms relieved from the acute phase to the chronic phase, and the CIP grade and Performance Status score decreased (P<0.05). The main change in radiologic features was the absorption of the lesions, and 3 (3/11) patients in the chronic phase had persistent traction bronchiectasis. For histologic features, most patients had acute fibrinous pneumonitis in the acute phase (5/8), and most had organizing pneumonia in the subacute phase (5/6). Other histologic changes advanced over time, with the lesions entering a state of fibrosis. Moreover, the levels of interleukin-6, interleukin-10 and high-sensitivity C-reactive protein (hsCRP) increased in the acute phase and decreased as CIP progressed (IL-6: 17.9 vs. 9.8 vs. 5.7, P=0.018; IL-10: 4.6 vs 3.0 vs. 2.0, P=0.041; hsCRP: 88.2 vs. 19.4 vs. 14.4, P=0.005).ConclusionsThe general development process of CIP can be divided into acute, subacute, and chronic phases, upon which a better management strategy might be based devised.
Keywords
- immune checkpoint inhibitor
- checkpoint inhibitor-related pneumonitis
- clinical phases
- management
- glucocorticoids
