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Cancer Immunol Res. 2019 Nov;7(11):1755-1759. doi: 10.1158/2326-6066.CIR-18-0717. Epub 2019 Aug 28.

Anti-PD-1-Induced Pneumonitis Is Associated with Persistent Imaging Abnormalities in Melanoma Patients.

Author information

1
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. douglas.b.johnson@vumc.org.
2
Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
4
Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
5
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
6
Department of Radiology, Moffitt Cancer Center, Tampa, Florida.
7
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
#
Contributed equally

Abstract

Pneumonitis may complicate anti-programmed death-1 (PD-1) therapy, although symptoms usually resolve with steroids. The long-term effects on respiratory function, however, are not well defined. We screened melanoma patients treated with anti-PD-1, with and without ipilimumab (anti-CTLA-4), and identified 31 patients with pneumonitis. Median time to radiographic findings was 4.8 months. Twenty-three patients (74%) presented with respiratory symptoms, whereas 8 (26%) were asymptomatic, and 11 (35%) were hospitalized. With 22.1 months median follow-up, 27 patients (87%) had resolution of symptoms, whereas 4 had persistent cough, dyspnea, and/or wheezing. By contrast, the rate of radiographic resolution was lower: Only 11 (35%) had complete radiographic resolution, whereas 14 (45%) had improvement of pneumonitis with persistent scarring or opacities, and 6 (19%) had persistent or worsened ground-glass opacities and/or nodular densities. Persistence (vs. resolution) of radiographic findings was associated with older age and initial need for steroids but not with need for hospitalization, timing of onset, or treatment regimen (combination vs. monotherapy). Among patients with serial pulmonary function tests, lung function improved with time. Although symptoms of anti-PD-1-induced pneumonitis resolved quickly, scarring or inflammation frequently persisted on computerized tomography. Therefore, further study of subclinical pulmonary effects of anti-PD-1 is needed.

PMID:
31462410
PMCID:
PMC6825579
[Available on 2020-05-01]
DOI:
10.1158/2326-6066.CIR-18-0717

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