A case report and literature review of immune checkpoint inhibitor-associated pneumonia caused by penpulimab

Objective From the perspective of intensive care physicians, this paper reviews the diagnosis and treatment of CIP patients, analyzes and refines relevant literature on CIP. To summarize the characteristics of diagnosis and treatment of severe CIP provides the basis and reference for early identification, diagnosis and treatment. Methods A case of severe CIP caused by piamprilizumab and ICI was reviewed and the literature was reviewed. Results This was a patient with lung squamous cell carcinoma with lymphoma who had been treated with multiple chemoradiotherapy and immunotherapy with piamprizumab. The patient was admitted to the ICU with respiratory failure. The intensive care physician performs anti-infective, fluid management, hormonal anti-inflammatory, respiratory and nutritional support treatment, and relies on mNGS to exclude severe infection and CIP treatment, thus successfully saving the patient's life and improving discharge. Conclusions The incidence of CIP is very low, and its diagnosis should be combined with clinical manifestations and previous drug use. mNGS can provide certain value in the exclusion of severe infections, so as to provide basis and reference for the early identification, diagnosis and treatment of severe CIP.

[1]  Lingyan Wang,et al.  Analysis of Negative Results of Metagenomics Next-Generation Sequencing in Clinical Practice , 2022, Frontiers in Cellular and Infection Microbiology.

[2]  I. Pavord,et al.  Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis , 2022, The Lancet Respiratory Medicine.

[3]  R. Pearse,et al.  Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis , 2021, British Journal of Anaesthesia.

[4]  B. Suktitipat,et al.  Risks and cancer associations of metachronous and synchronous multiple primary cancers: a 25-year retrospective study , 2021, BMC Cancer.

[5]  B. Yu,et al.  1169TiP Penpulimab-based combination neoadjuvant/adjuvant therapy for patients with resectable locally advanced non-small cell lung cancer: A phase II clinical study (ALTER-L043) , 2021, Annals of Oncology.

[6]  Q. Zhang,et al.  Immune Checkpoint Inhibitor-Associated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management , 2021, Frontiers in Immunology.

[7]  Yuankai Shi,et al.  Penpulimab plus anlotinib as second-line treatment for the small cell lung cancer after failure of platinum-based systemic chemotherapy. , 2021, Journal of Clinical Oncology.

[8]  L. Sehn,et al.  Diffuse Large B-Cell Lymphoma. , 2021, The New England journal of medicine.

[9]  T. Schwartz,et al.  Immune checkpoint inhibitor-related pneumonitis in lung cancer: real-world incidence, risk factors, and management practices across six health care centers in North Carolina. , 2021, Chest.

[10]  G. Zhuang,et al.  Radiographic features and prognosis of early- and late-onset non-small cell lung cancer immune checkpoint inhibitor-related pneumonitis , 2021, BMC cancer.

[11]  M. Suarez‐Almazor,et al.  Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events: pulmonary toxicity , 2020, Supportive Care in Cancer.

[12]  P. Illei,et al.  Immune-Related Pneumonitis After Chemoradiotherapy and Subsequent Immune Checkpoint Blockade in Unresectable Stage III Non-Small-Cell Lung Cancer. , 2020, Clinical lung cancer.

[13]  Honglong Wu,et al.  Diagnostic value and clinical application of next-generation sequencing for infections in immunosuppressed patients with corticosteroid therapy , 2020, Annals of translational medicine.

[14]  Douglas B. Johnson,et al.  Increased reporting of fatal pneumonitis associated with immune checkpoint inhibitors: a WHO pharmacovigilance database analysis , 2020, European Respiratory Journal.

[15]  M. Burns,et al.  Case-Control Study , 2020, Definitions.

[16]  John O. Prior,et al.  Relationship between pneumonitis induced by immune checkpoint inhibitors and the underlying parenchymal status: a retrospective study , 2020, ERJ Open Research.

[17]  C. Lin,et al.  The alveolar immune cell landscape is dysregulated in checkpoint inhibitor pneumonitis. , 2019, The Journal of clinical investigation.

[18]  J. Martinez-Climent,et al.  PD-1/PD-L1 immune checkpoint and p53 loss facilitate tumor progression in activated B-cell diffuse large B-cell lymphomas. , 2019, Blood.

[19]  M. Kusumoto,et al.  Radiologic features of pneumonitis associated with nivolumab in non-small-cell lung cancer and malignant melanoma. , 2019, Future oncology.

[20]  K. Straif,et al.  Pesticide use and risk of non-Hodgkin lymphoid malignancies in agricultural cohorts from France, Norway and the USA: a pooled analysis from the AGRICOH consortium , 2019, International journal of epidemiology.

[21]  Emily C. Zhu,et al.  Risk of Pneumonitis and Pneumonia Associated With Immune Checkpoint Inhibitors for Solid Tumors: A Systematic Review and Meta-Analysis , 2019, Front. Immunol..

[22]  Douglas B. Johnson,et al.  Biomarkers for Immunotherapy Toxicity: Are Cytokines the Answer? , 2018, Clinical Cancer Research.

[23]  C. Lin,et al.  Immune Checkpoint Immunotherapy for Non-Small Cell Lung Cancer: Benefits and Pulmonary Toxicities. , 2018, Chest.

[24]  R. Sullivan,et al.  Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis , 2018, JAMA oncology.

[25]  J. Soria,et al.  Long-Term Survival in Patients Responding to Anti–PD-1/PD-L1 Therapy and Disease Outcome upon Treatment Discontinuation , 2018, Clinical Cancer Research.

[26]  Z. Lv,et al.  The association between rs12885713 polymorphism in CALM1 and risk of osteoarthritis , 2018, Medicine.

[27]  P. Cui,et al.  Risk factors for pneumonitis in patients treated with anti‐programmed death‐1 therapy: A case‐control study , 2018, Cancer medicine.

[28]  D. Elston,et al.  When worlds collide: Th17 and Treg cells in cancer and autoimmunity , 2018, Cellular & Molecular Immunology.

[29]  M. Delgado-Rodríguez,et al.  Systematic review and meta-analysis. , 2017, Medicina intensiva.

[30]  M. Antonelli,et al.  Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study , 2017, Intensive Care Medicine.

[31]  S. Keenan,et al.  Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure , 2017, European Respiratory Journal.

[32]  B. Carneiro,et al.  Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis , 2017, Cancer management and research.

[33]  N. Reinmuth,et al.  Combined immune checkpoint blockade (anti-PD-1/anti-CTLA-4): Evaluation and management of adverse drug reactions. , 2017, Cancer treatment reviews.

[34]  A. Mackiewicz,et al.  Programmed cell death 1 checkpoint inhibitors in the treatment of patients with advanced melanoma , 2017, Contemporary oncology.

[35]  C. Zahnow,et al.  Evolution of Neoantigen Landscape during Immune Checkpoint Blockade in Non-Small Cell Lung Cancer. , 2017, Cancer discovery.

[36]  C. Rudin,et al.  Pneumonitis in Patients Treated With Anti-Programmed Death-1/Programmed Death Ligand 1 Therapy. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[37]  M. Millenson,et al.  Nivolumab in Patients With Relapsed or Refractory Hematologic Malignancy: Preliminary Results of a Phase Ib Study. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[38]  G. Zalcman,et al.  Nivolumab-induced organizing pneumonitis in a patient with lung sarcomatoid carcinoma. , 2016, Lung cancer.

[39]  F. Hodi,et al.  PD-1 Inhibitor–Related Pneumonitis in Advanced Cancer Patients: Radiographic Patterns and Clinical Course , 2016, Clinical Cancer Research.

[40]  Chao Lu,et al.  Retrospective study , 2016, Medicine.

[41]  J. Wolchok,et al.  Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. , 2015, Annals of oncology : official journal of the European Society for Medical Oncology.

[42]  S. Margolin,et al.  CEREBEL (EGF111438): A Phase III, Randomized, Open-Label Study of Lapatinib Plus Capecitabine Versus Trastuzumab Plus Capecitabine in Patients With Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[43]  J. Masip,et al.  Noninvasive ventilation in acute respiratory failure , 2014, International journal of chronic obstructive pulmonary disease.

[44]  M. Niazi,et al.  Concurrent Lung Squamous Cell Carcinoma and Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-associated Lymphoid Tissue Type , 2014, Journal of bronchology & interventional pulmonology.

[45]  S. Chevret,et al.  Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium--a groupe de recherche respiratoire en réanimation onco-hématologique study. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[46]  H. Weir,et al.  The effect of multiple primary rules on population-based cancer survival , 2013, Cancer Causes & Control.

[47]  E. Ferguson,et al.  Lung CT: Part 2, The interstitial pneumonias--clinical, histologic, and CT manifestations. , 2012, AJR. American journal of roentgenology.

[48]  J. Armitage,et al.  Non-Hodgkin lymphoma , 2012, The Lancet.

[49]  M. Antonelli,et al.  Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: A 5-year multicenter observational survey* , 2011, Critical care medicine.

[50]  S. Nava,et al.  Faculty Opinions recommendation of Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. , 2011 .

[51]  A. Wölfler,et al.  Therapy‐related myeloid neoplasms: pathobiology and clinical characteristics , 2011, British journal of pharmacology.

[52]  J. Cravedi,et al.  Occupational exposure to pesticides and risk of hematopoietic cancers: meta-analysis of case–control studies , 2007, Cancer Causes & Control.

[53]  T. Randall,et al.  B Cells Are Required for Generation of Protective Effector and Memory CD4 Cells in Response to Pneumocystis Lung Infection , 2006, The Journal of Immunology.

[54]  I. D. Johnston,et al.  American thoracic society/European respiratory society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias , 2002 .

[55]  N. Müller,et al.  Acute interstitial pneumonia: radiographic and CT findings in nine patients. , 1993, Radiology.

[56]  C. Taylor Diagnostic imaging techniques in the evaluation of drug-induced pulmonary disease. , 1990, Clinics in chest medicine.

[57]  K. Kerr,et al.  Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. , 2018, Annals of oncology : official journal of the European Society for Medical Oncology.

[58]  A. Malhotra,et al.  Treatment of ARDS With Prone Positioning. , 2017, Chest.

[59]  J. Cerhan,et al.  Medical history, lifestyle, family history, and occupational risk factors for marginal zone lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. , 2014, Journal of the National Cancer Institute. Monographs.

[60]  J. Cerhan,et al.  Medical history, lifestyle, family history, and occupational risk factors for diffuse large B-cell lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. , 2014, Journal of the National Cancer Institute. Monographs.