Pulmonary Toxicity

OVERVIEW

GUIDELINES

Pulmonary – Pneumonitis1

h CT with contrast to rule out other etiologies if not contraindicated
i Viral pathogen assessment should include COVID-19
j Immunocompromised panel may include CBC with differential, bacterial culture, and Gram stain; AFB culture and stain; fungal immunoassay, culture, and silver stain; CMV, HSV, PJP, and respiratory virus PCR
k Treat until symptoms improve to Grade ≤1, then taper over 4–6 weeks

Pulmonary – Pneumonitis2

Pulmonary – Pneumonitis3

INCIDENCE

Immune-mediated Pneumonitis in Patients Treated with Single-agent Pembrolizumab

ONSET & DURATION

Pembrolizumab: imAE Median Times to Onset and Duration in Affected Patients – Pneumonitis4

IMMUNE-RELATED PNEUMONITIS IN PATIENTS TREATED WITH PEMBROLIZUMAB (94/2,799)

References:

  1. NCCN (National Comprehensive Cancer Network) V.1.2023. Accessed at: https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf. Last accessed: 1-5-2023.
  2. Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. Journal of clinical oncology. 2023;39(36):4073-126
  3. Haanen J, Obeid M, Spain L, Carbonnel F, Wang Y, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. 2022;33(12):1217-38
  4. Egyptian drug authority KEYTRUDA® leaflet approval date: 23/05/2023

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