Highlights
- •Here we present the first analysis of radiographic findings of IRAE pneumonitis versus pneumonitis caused by chemotherapy
- •Immunotherapy was associated pulmonary nodules and the number of immunotherapy agents correlated with incidence of pulmonary nodules
- •Features of IRAE pneumonitis improved over time while those of chemotherapy pneumonitis worsened
Abstract
Background
Pneumonitis has been described as a side effect of immunotherapy as well as traditional
chemotherapy. Although immune-related adverse event (IRAE) pneumonitis has been extensively
characterized, the relationship between IRAE pneumonitis and pneumonitis secondary
to chemotherapy is less clear. Here, we present the first analysis of radiographic
features of pneumonitis secondary to immunotherapy compared to chemotherapy.
Methods
Using our radiology records system, we searched chest computed tomography (CT) reports
for the term “pneumonitis”. We evaluated medical records to establish chronicity of
pneumonitis occurring after medication administration and excluded cases where radiation
therapy appeared to be the cause of pneumonitis. We also obtained information regarding
demographic, clinical, and treatment characteristics for comparison.
Results
Patients treated with immunotherapy demonstrated more specific features of pneumonitis
including consolidation, ground glass opacities, septal thickening, traction bronchiectasis,
and pulmonary nodules compared to those treated with chemotherapy. Immunotherapy treatment
correlated with the development of pulmonary nodules (p = 0.048), and administration
of more than one immunotherapy agent correlated with a greater incidence of development
of nodules (p = 0.050). Radiographic features in patients treated with immunotherapy
all decreased over time. Conversely, in patients treated with chemotherapy the incidence
of ground glass opacities, traction bronchiectasis, pulmonary nodules, and mediastinal/hilar
adenopathy increased over time.
Conclusions
IRAE-pneumonitis has distinct features and a distinct clinical course compared to
pneumonitis secondary to chemotherapy. Importantly, IRAE-pneumonitis features decreased
over time, suggesting that careful consideration of the benefit-risk ratio may allow
for continuation of immunotherapy in some patients who develop pneumonitis.
Keywords
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Article Info
Publication History
Published online: March 09, 2022
Accepted:
March 6,
2022
Received in revised form:
March 4,
2022
Received:
November 28,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
