Dr. Naidoo on Studies of Immune-Related Adverse Events in Lung Cancer

Jarushka Naidoo, MBBCh, assistant professor of oncology, Johns Hopkins University, discusses studies investigating immune-related adverse events for patients with lung cancer.

In the pneumonitis field, there was a study published in the Journal of Clinical Oncology in 2017 of a collaboration between Memorial Sloan Kettering Cancer Center and the Melanoma Institute of Australia. That series included more than 40 patients with solid tumors who developed pneumonitis as a result of immune checkpoint inhibitors. These were mainly patients with lung cancer and melanoma. What was novel about that study was that it comprehensively reported that pneumonitis can occur at any time during the treatment of a patient with immunotherapy. It has since been reported that this can even occur after immunotherapy has stopped, explains Naidoo.

The other seminal observation, which is highlighted in the guidelines, is that each case of pneumonitis is not all created equal, says Naidoo. There may be variable radiographic appearances associated with it. Clinicians should be aware that if a patient develops a new cough, shortness of breath, fever, or chest pain, and they do a CT scan, that pneumonitis doesn't have a classic appearance. The appearances may range from organizing pneumonia, ground glass opacities, hypersensitivity, interstitial, or not otherwise specified, which is a mix of all 4 of those appearances.