IMMUNOTHERAPY-INDUCED PNEUMONITIS – CASE REPORT

Abstract

Lung carcinoma remains the leading cause of cancer mortality. Immunotherapy with checkpoint inhibitors, such as nivalumab and pembrolizumab, is an effective option for the treatment of non-small cell lung cancer, resulting in prolonged progression-free survival compared with conventional chemotherapy. These innovative types of medication, however, define a different type of side effects – immune related adverse events (irAEs) that can affect almost any organ and system. Immune-mediated pneumonitis is not uncommon, but it is a serious and potentially life-threatening condition. It affects 2-4% of patients on monotherapy and up to 6.6% of patients on combined immunotherapy. A well-established approach to the treatment of immune related adverse events is lacking. We present a clinical case of a 54-year-old man with verified non-small cell lung carcinoma who underwent one course of combined immunotherapy with nivolumab and ipilimumab, inducing CTCAE (Common Terminology Criteria for Adverse Effects) grade 3 pneumonitis, hepatitis and skin toxicity requiring emergency hospitalization. Corticosteroid pulse therapy was administered, followed by dose tapering for 5 weeks. The case supports the effectiveness of pulse corticosteroid therapy in the treatment of severe immune-mediated pneumonitis (G3) refractory to standard high-dose corticosteroid combined with liver and skin toxicity.