MANAGEMENT OF IMMUNE CHECKPOINT INHIBITOR-RELATED PNEUMONITIS IN PATIENTS WITH ESOPHAGEAL CANCER: A NARRATIVE REVIEW WITH 3 ILLUSTRATIVE CLINICAL CASES AT VIETNAM NATIONAL CANCER HOSPITAL
Main Article Content
Abstract
Objective: To synthesize updated evidence regarding the epidemiology, pathogenesis, clinical characteristics, diagnosis, management, and indications for immune checkpoint inhibitor rechallenge in patients with immune checkpoint inhibitor related interstitial pneumonia.
Methods: A narrative review was performed based on a systematic search of studies published between 2018 and 2026. Three clinical cases treated in Vietnam National Cancer Hospital are presented to illustrate common scenarios encountered in routine practice.
Results: Immune checkpoint inhibitor-related interstitial pneumonia presents with highly heterogeneous clinical and radiological manifestations. Corticosteroids remain the mainstay of treatment. The decision to resume immune checkpoint inhibitor should be carefully individualized.
Conclusions: Although rare, immune checkpoint inhibitor-related interstitial pneumonia is a treatment-altering complication that requires appropriate diagnostic work-up and therapeutic strategies.
Article Details
Keywords
Esophageal cancer, immune checkpoint inhibitors, interstitial pneumonia, Pembrolizumab, immune-related adverse events.
References
[2] Lu Z, Wang J, Shu Y et al. Sintilimab versus placebo in combination with chemotherapy as first line treatment for locally advanced or metastatic oesophageal squamous cell carcinoma (ORIENT-15): multicentre, randomised, double blind, phase 3 trial. BMJ, 2022, 377: e068714. doi: 10.1136/bmj-2021-068714.
[3] Doki Y, Ajani J.A, Kato K et al. Nivolumab combination therapy in advanced esophageal squamous-cell carcinoma. New England Journal of Medicine, 2022, 386 (5): 449-462. doi: 10.1056/NEJMoa2111380.
[4] Janjigian Y.Y, Shitara K, Moehler M et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet, 2021, 398 (10294): 27-40. doi: 10.1016/S0140-6736(21)00797-2
[5] Luo H, Lu J, Bai Y et al. Effect of Camrelizumab vs placebo added to chemotherapy on survival and progression-free survival in patients with advanced or metastatic esophageal squamous cell carcinoma: the ESCORT-1st randomized clinical trial. JAMA, 2021, 326 (10): 916-925. doi: 10.1001/jama.2021.12836
[6] Nishino M, Giobbie-Hurder A, Hatabu H, Ramaiya N.H, Hodi F.S. Incidence of Programmed Cell Death 1 inhibitor-related pneumonitis in patients with advanced cancer: a systematic review and meta-analysis. JAMA Oncol, 2016, 2 (12): 1607-1616. doi: 10.1001/jamaoncol.2016.2453
[7] Khunger M, Rakshit S, Pasupuleti V et al. Incidence of pneumonitis with use of Programmed Death 1 and Programmed Death-Ligand 1 inhibitors in non-small cell lung cancer. Chest, 2017, 152 (2): 271-281. doi: 10.1016/j.chest.2017.04.177
[8] Postow M.A, Sidlow R, Hellmann M.D. Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med, 2018, 378 (2): 158-168. doi: 10.1056/NEJMra1703481
[9] Delaunay M, Cadranel J, Lusque A et al. Immune-checkpoint inhibitors associated with interstitial lung disease in cancer patients. Eur Respir J, 2017, 50 (2). doi: 10.1183/13993003.00050-2017
[10] Brahmer J.R, Lacchetti C, Schneider B.J et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol Off J Am Soc Clin Oncol, 2018, 36 (17): 1714-1768. doi: 10.1200/JCO.2017.77.6385
[11] Brahmer J.R, Abu-Sbeih H, Ascierto P.A et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer, 2021, 9 (6): e002435. doi: 10.1136/jitc-2021-002435
[12] Haanen J, Obeid M et al. Management of toxicities from immunotherapy: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Annals of Oncology, 2022, 33 (12): 1217-1238. doi: 10.1016/j.annonc.2022.10.001.
[13] Thompson J.A, Schneider B.J, Brahmer J et al. NCCN Guidelines® Insights: Management of immunotherapy-related toxicities, version 2.2024. J Natl Compr Cancer Netw, 2024, 22 (9): 582-592. doi: 10.6004/jnccn.2024.0057