1
|
Kawakami N, Saito H, Takahashi S, Kajie S, Kato R, Shimaya K, Wakai Y, Saito K, Sakashita M. Airway disorders associated with immune checkpoint inhibitor therapy: Two case reports and a systematic review. Semin Oncol 2022; 49:439-455. [PMID: 36759235 DOI: 10.1053/j.seminoncol.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Immune checkpoint inhibitors (ICI) are widely used for the treatment of various malignant neoplasms. Interstitial lung disease is a well-known immune-related adverse event, however, ICI-induced airway disease remains under-recognized. Herein, we report two similar cases of pembrolizumab-induced tracheobronchitis presenting as persistent chronic cough and dyspnea. Blood tests revealed elevated C-reactive protein levels without eosinophilia. Spirometry demonstrated mild airflow obstruction. Computed tomography revealed diffuse thickening of the tracheobronchial walls and bronchiectasis predominantly in the lower lobes. Bronchoscopy revealed edematous and erythematous tracheobronchial mucosa, and bronchial biopsy tissue exhibited marked inflammation with predominant infiltration of CD8+ lymphocytes. Subsequently, pembrolizumab-induced tracheobronchitis was diagnosed in both cases. Cessation of pembrolizumab and initiation of erythromycin, inhaled corticosteroids, and long-acting beta-agonists gradually improved the symptoms, airflow obstruction, and radiographic findings. These were completely resolved in one case. The other case initially showed a poor response to systemic corticosteroids combined with the aforementioned drugs, but improved gradually and almost completely. These cases exemplify ICI-induced airway disease that is, an under-recognized manifestation of immune-related adverse events. In addition, we have systematically searched the PubMed database for articles on ICI-induced airway disease, categorized the retrieved articles as eosinophilic and non-eosinophilic airway diseases, and reviewed the differences in treatment and prognoses between these two categories.
Collapse
Affiliation(s)
- Naoki Kawakami
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
| | - Hiroaki Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Susumu Takahashi
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinpei Kajie
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Rina Kato
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Kazuhiro Shimaya
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoko Wakai
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Kazuhito Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Mai Sakashita
- Department of Pathology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| |
Collapse
|
2
|
Araujo DV, Muniz TP, Yang A, Keshavarzi S, Sorotsky H, Butler MO, Saibil S, Spreafico A, Hogg D. Real World Outcomes and Hepatotoxicity of Infliximab in the Treatment of Steroid-Refractory Immune-Related Adverse Events. ACTA ACUST UNITED AC 2021; 28:2173-2179. [PMID: 34208089 PMCID: PMC8293058 DOI: 10.3390/curroncol28030201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 02/08/2023]
Abstract
Background and aims: Current guidelines state that infliximab is contraindicated for the treatment of immune checkpoint inhibitor-related hepatitis (ir-hepatitis) due to the risk of inducing further liver damage. As this recommendation is largely based on the use of infliximab for rheumatologic diseases, we evaluated the efficacy and hepatotoxicity of infliximab in patients with steroid-refractory immune-related adverse events (irAEs). Methods: We retrospectively reviewed consecutive patients treated with infliximab for irAEs at Princess Margaret Cancer Centre. To assess hepatotoxicity, we compared the mean value of ALT, AST, and total bilirubin (BT) before and after infliximab treatment. We used logistic regression to assess factors associated with infliximab efficacy. Results: Between January 2010 and February 2019, 56 patients were identified. The median age of the patients was 63 (27–84) years. Colitis was the most frequent toxicity (66%), followed by pneumonitis (11%). Infliximab was used to treat ir-hepatitis in one patient. The median number of infliximab doses was 1 (1–3) and led to toxicity resolution in 43 (76%) patients. The mean ALT, AST, and BT levels before and after infliximab treatment were not statistically different. The patient treated for ir-hepatitis had a complete recovery, with no incremental liver toxicity. Conclusions: In this dose-limited setting, infliximab was effective in resolving irAEs and did not induce hepatotoxicity.
Collapse
Affiliation(s)
- Daniel V. Araujo
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada; (T.P.M.); (H.S.); (M.O.B.); (S.S.); (A.S.); (D.H.)
- Department of Medical Oncology, Hospital de Base, Sao Jose do Rio Preto 15090 000, Brazil
- Correspondence: ; Tel.:+55-17-3201-5096
| | - Thiago Pimentel Muniz
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada; (T.P.M.); (H.S.); (M.O.B.); (S.S.); (A.S.); (D.H.)
| | - Anjie Yang
- Department of Pharmacy, University Health Network, Toronto, ON M5G 2M9, Canada;
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada;
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Hadas Sorotsky
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada; (T.P.M.); (H.S.); (M.O.B.); (S.S.); (A.S.); (D.H.)
- Cancer Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan 52621, Israel
| | - Marcus O. Butler
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada; (T.P.M.); (H.S.); (M.O.B.); (S.S.); (A.S.); (D.H.)
| | - Samuel Saibil
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada; (T.P.M.); (H.S.); (M.O.B.); (S.S.); (A.S.); (D.H.)
| | - Anna Spreafico
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada; (T.P.M.); (H.S.); (M.O.B.); (S.S.); (A.S.); (D.H.)
| | - David Hogg
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada; (T.P.M.); (H.S.); (M.O.B.); (S.S.); (A.S.); (D.H.)
| |
Collapse
|