Immune checkpoint inhibitors (ICI), or immunotherapeutic agents, are becoming more popular as they become approved to treat various cancers, including non-small cell lung cancer.
“There’s a lot of evidence to suggest these drugs are superior to chemotherapy, especially in advanced cancer,” said Karthik Suresh, MD, of Johns Hopkins University. “So there’s excitement to use these drugs in a wide variety of patients.”
However, in part because these agents work differently than traditional chemotherapeutic drugs, they are also associated with new toxicities and immune-related adverse events, including checkpoint inhibitor associated pneumonitis (CIP).
Dr. Suresh will chair the session Checkpoint Inhibitor Pneumonitis: Current Concepts in Incidence, Diagnosis and Management on Tuesday at 8:45 am in room 267 of the convention center, which will focus on the emerging use of ICIs in solid and hematologic malignancies, the incidence, risk factors, clinical presentation, and management strategies for CIP.
This condition (CIP) was originally thought to happen in 2% to 3% of patients who received ICIs, but as these drugs have expanded outside of clinical trials and the use has broadened, the medical community is realizing that the incidence may be higher, Dr. Suresh said.
“I think that’s probably attributable to a number of factors, including a widening array of patients that are being offered these medications,” he said. “As well as increased pharmacovigilance.”
There can be several adverse events from ICI, Dr. Suresh noted, but this session is specifically focusing on CIP, since recent evidence suggests that it may be associated with increased mortality.
“Exertional desaturation and presence of new radiographic infiltrates are clues that a patient might have pneumonitis,” he said. “However, a lot of times these patients present as if they have pneumonia or some another more commonly seen diseases.”
Dr. Suresh said CIP is treated through high-dose steroids. It’s important to learn how to recognize it so it can be treated quickly.
“Most of the guidelines are largely based on anecdotal evidence,” Dr. Suresh said. “It’s not really based on clinical trials or head-to-head comparisons. Right now, the main stay of therapy is to stop the drug, give steroids, and then watch for improvement. From a research standpoint, we’re trying to understand this disease better biologically. Because if we can do that, then we might be able to come up with a more targeted therapy.”
Dr. Suresh said the medical community has looked at risk factors to indicate CIP, but haven’t been able to pinpoint anything modifiable that the patient could possibly do or the physician could do to try to avoid this.
“As physicians, we would love to be able to point to a biomarker, something on imaging, or something else about the patient that could at least help predict who would develop CIP,” he said. “Unfortunately, the research just isn’t there yet.”
There are three key messages Dr. Suresh wants attendees to come away with from session, he said. One is that pneumonitis is probably more common than previously established, and people need to have a high index of suspicion when anybody who’s been on an immunotherapy agent presents with any sort of respiratory symptom. Second is that “Pneumonitis can look like a lot of other things, including other immune-related adverse events,” he said. Thirdly, “Consulting in a multidisciplinary fashion with a pulmonologist, radiologist, and oncologist is highly recommended.”