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BMJ Case Reports 2018; doi:10.1136/bcr-2018-225937
  • Unexpected outcome (positive or negative) including adverse drug reactions
  • CASE REPORT

Severe pneumonitis refractory to steroids following anti-PD-1 immunotherapy

  1. Vishesh Paul3
  1. 1Internal Medicine, College of Medicine, University of Illinois, Urbana, Illinois, USA
  2. 2Hematology & Oncology, Carle Foundation Hospital, Urbana, Illinois, USA
  3. 3Pulmonology & Critical Care, Carle Foundation Hospital, Urbana, Illinois, USA
  1. Correspondence to Dr Neal Andruska, nandrus2{at}illinois.edu, nandrus59{at}gmail.com
  • Accepted 12 September 2018
  • Published 8 October 2018

Summary

Anti-programmed death 1 (PD-1) immune checkpoint inhibitors enhance the antitumour activity of the immune system and have produced durable tumour responses in several solid tumours including non-small cell lung cancer (NSCLC). However, PD-1 inhibitors can lead to immune-related adverse events , including pneumonitis, which is typically mild, but can be severe and potentially fatal. Pneumonitis often resolves with steroids, but some cases are steroid refractory, leading to a relapsing and remitting course in milder cases or the need for salvage therapies in more severe cases. Here, we present two patients with NSCLC who developed severe pneumonitis following therapy with nivolumab and pembrolizumab. While one patient improved with steroids and infliximab, the other patient failed to respond to steroids and subsequently died. These cases demonstrate the highly variable presentation and therapeutic responses seen in patients with pneumonitis following anti-PD-1 therapy and illustrate that severe cases can often present refractory to steroid therapy.

Footnotes

  • Contributors NA, LM, CH, PP and VP were involved in the care of patients, data acquisition and interpretation, and drafting of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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