Abstract
Immune-checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death-1 (PD-1), and programmed cell death-1-ligand 1 (PD-L1) have become new treatment options for various malignancies. ICIs bind to immune-checkpoint inhibitory receptors or to the foregoing ligands and block inhibitory signals to release the brakes on the immune system, thereby enhancing immune anti-tumor responses. On the other hand, unlike conventional chemotherapies, ICIs can cause specific side effects, called immune-related adverse events (irAEs). These toxicities may affect various organs, including the lungs. ICI-related pneumonitis (ICI-pneumonitis) is not the most frequent adverse event, but it is serious and can be fatal. In this review, we summarize recent findings regarding ICI-pneumonitis, with a focus on potential pathogenesis and treatment.
Highlights
Biomedicines 2021, 9, 1484. https://Immune-checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death-1 (PD-1), and programmed cell death-1-ligand 1 (PD-L1) have provided substantial benefits to many cancer patients [1,2,3,4]
We previously reported that T-cell-dominated lymphocytosis is evident in bronchoalveolar lavage fluid (BALF) from Immune-checkpoint inhibitors (ICIs)-pneumonitis [23,24], which is consistent with other case series [25,26,27]
A chest CT scan is important for the diagnosis of interstitial lung diseases (ILDs) and is important for ICI-pneumonitis [52]
Summary
Immune-checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death-1 (PD-1), and programmed cell death-1-ligand 1 (PD-L1) have provided substantial benefits to many cancer patients [1,2,3,4]. ICIs utilize the immune response to tumor antigens by activating T cells [5,6]. These agents target the same pathways that maintain immune tolerance and prevent autoimmunity, inducing immunerelated adverse events (irAEs), including pneumonitis, hypophysitis, diabetes, colitis, thyroiditis, and others [7,8,9,10,11]. ICI-pneumonitis represents the most common fatal irAE from anti-PD-1/PD-L1 monotherapy, accounting for 35% of anti-PD-1/PD-L1related deaths [12].
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