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Review | Open Access

The mechanism and risk factors for immune checkpoint inhibitor pneumonitis in non-small cell lung cancer patients

Xiaoyang Zhai1,*, Jian Zhang2,*, Yaru Tian1,3, Ji Li1, Wang Jing1, Hongbo Guo2( ), Hui Zhu1( )
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
Department of Radiation Oncology, Shandong Cancer Hospital and Institute affiliated with Shandong University, Jinan 250012, China

*These authors contributed equally to this work.

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Abstract

Immune checkpoint inhibitors (ICIs) are new and promising therapeutic agents for non-small cell lung cancer (NSCLC). However, along with demonstrating remarkable efficacy, ICIs can also trigger immune-related adverse events. Checkpoint inhibitor pneumonitis (CIP) has been reported to have a morbidity rate of 3% to 5% and a mortality rate of 10% to 17%. Moreover, the incidence of CIP in NSCLC is higher than that in other tumor types, reaching 7% to 13%. With the increased use of ICIs in NSCLC, CIP has drawn extensive attention from oncologists and cancer researchers. Identifying high risk factors for CIP and the potential mechanism of CIP are key points in preventing and monitoring serious adverse events. In this review, the results of our analysis and summary of previous studies suggested that the risk factors for CIP may include previous lung disease, prior thoracic irradiation, and combinations with other drugs. Our review also explored potential mechanisms closely related to CIP, including increased T cell activity against associated antigens in tumor and normal tissues, preexisting autoantibodies, and inflammatory cytokines.

Keywords

risk factorsImmune checkpoint inhibitornon-small-cell lung cancerpneumonitis

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Cancer Biology & Medicine
Volume 17 Issue 3,
August 2020
Pages 599-611
DOI: 10.20892/j.issn.2095-3941.2020.0102
Cite this article:
Zhai X, Zhang J, Tian Y, et al. The mechanism and risk factors for immune checkpoint inhibitor pneumonitis in non-small cell lung cancer patients. Cancer Biology & Medicine, 2020, 17(3): 599-611. https://doi.org/10.20892/j.issn.2095-3941.2020.0102

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Received: 30 March 2020
Accepted: 27 May 2020
Published: 15 August 2020
©2020 Cancer Biology & Medicine.

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