Immune-Related Adverse Events: Pneumonitis

Abstract

Checkpoint inhibitors are part of the family of immunotherapies and are increasingly being used in a wide variety of cancers. Immune-related adverse events pose a major challenge in the treatment of cancer patients. Pneumonitis is a rare immune-related adverse event that presents in distinct patterns. The goal of this chapter is to instruct readers on the incidence and clinical manifestations of pneumonitis and to offer guidance in the evaluation and treatment of patients with pneumonitis.

Keywords: Checkpoint inhibitors; Diffuse alveolar damage; Hypersensitivity pneumonitis; Immune-related adverse event; Nonspecific interstitial pneumonia; Organizing pneumonia; Pneumonitis; Thoracic imaging.

Fig. 13.1

Representative images of (a) nonspecific interstitial pneumonitis, (b) organizing pneumonia, and (c) diffuse alveolar damage in patients receiving precision oncology therapies

Fig. 13.2

Buds of granulation tissue (arrows) in the lumen of alveoli. (Reproduced with permission from Clinical Respiratory Medicine, Cottin V. and Cordier J., 2012, Elsevier Publishing)

Fig. 13.3

Pathological findings of diffuse alveolar damage. (a) Diffuse alveolar damage in the acute phase. The interstitium is edematous. Hyaline membrane (arrow) is seen lining the alveolar ducts (hematoxylin and eosin stain, ×100). (b) Diffuse alveolar damage in the organizing phase. The interstitium is thickened with organizing connective tissue. Prominent type 2 pneumocyte hyperplasia is seen (hematoxylin and eosin stain, ×200) [71]