Abstract
Background: Lung cancer is one of the most common and mortal cancers worldwide. According to pathological and clinical groups, treatments vary, and a tailored approach is considered. Adjuvant therapies, such as chemotherapy, radiation, and immune checkpoint inhibitors (ICI), are recommended by recent guidelines for patients with locally advanced cancer.
Objective: This study aimed to report the case of a patient with stage 2B squamous cell lung carcinoma who was managed for pulmonary toxicity after receiving adjuvant chemotherapy and atezolizumab treatment.
Case Report: A 66-year-old male patient received chemotherapy and immunotherapy after surgery for squamous cell lung cancer. A diagnosis of atezolizumab-associated pneumonitis was made using laboratory tests and imaging due to the patient's worsening dyspnea after treatment. Due to the patient's rapid progression, pulse steroid and MMF therapy were administered concurrently. When Klebsiella pneumoniae growth was detected in the sputum culture during the follow-up, IVIg was used to supplement the medication. The patient showed significant clinical and radiological improvement.
Conclusion: In this study, we present an atezolizumab-induced pneumonitis case of a squamous cell lung cancer patient. It may be life-saving not to avoid aggressive treatment approaches by combining the steps of guideline recommendations in patients with rapidly progressive pneumonitis.
[1]
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021; 71(1): 7-33.
[http://dx.doi.org/10.3322/caac.21654] [PMID: 33433946]
[http://dx.doi.org/10.3322/caac.21654] [PMID: 33433946]
[2]
National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology (NCCN guidelines®): non-small cell lung cancer. V5 2022.
[3]
Reichert JM. Antibodies to watch in 2016. MAbs 2016; 8(2): 197-204.
[http://dx.doi.org/10.1080/19420862.2015.1125583] [PMID: 26651519]
[http://dx.doi.org/10.1080/19420862.2015.1125583] [PMID: 26651519]
[4]
Felip E, Altorki N, Zhou C, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB–IIIA non-small-cell lung cancer (IMpower010): A randomised, multicentre, open-label, phase 3 trial. Lancet 2021; 398(10308): 1344-57.
[http://dx.doi.org/10.1016/S0140-6736(21)02098-5] [PMID: 34555333]
[http://dx.doi.org/10.1016/S0140-6736(21)02098-5] [PMID: 34555333]
[5]
Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): A phase 3, open-label, multicentre randomised controlled trial. Lancet 2017; 389(10066): 255-65.
[http://dx.doi.org/10.1016/S0140-6736(16)32517-X] [PMID: 27979383]
[http://dx.doi.org/10.1016/S0140-6736(16)32517-X] [PMID: 27979383]
[6]
Wang PF, Chen Y, Song SY, et al. Immune-related adverse events associated with anti-PD-1/PD-L1 treatment for malignancies: A meta-analysis. Front Pharmacol 2017; 8: 730.
[http://dx.doi.org/10.3389/fphar.2017.00730] [PMID: 29093678]
[http://dx.doi.org/10.3389/fphar.2017.00730] [PMID: 29093678]
[7]
Reuss JE, Suresh K, Naidoo J. Checkpoint inhibitor pneumonitis: Mechanisms, characteristics, management strategies, and beyond. Curr Oncol Rep 2020; 22(6): 56.
[http://dx.doi.org/10.1007/s11912-020-00920-z] [PMID: 32415399]
[http://dx.doi.org/10.1007/s11912-020-00920-z] [PMID: 32415399]
[8]
Ramos-Casals M. Immune-related adverse events of checkpoint inhibitors. Nat Rev Dis Pri 2020; 6(1): 38.
[9]
Brahmer JR. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J immunoth cancer 2021; 9(6): e002435.
[10]
Brahmer JR. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American society of clinical oncology clinical practice guideline. J Clin Oncol: Offic J Am Soc Clin Oncol 2018; 36(17): 1714-68.
[11]
Haanen JBAG, Carbonnel F, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28(4): iv119-42.
[http://dx.doi.org/10.1093/annonc/mdx225] [PMID: 28881921]
[http://dx.doi.org/10.1093/annonc/mdx225] [PMID: 28881921]
[12]
NCCN Clinical Practice Guidelines in Oncology. Management of immunotherapy-related toxicities, version 1.2022, nccn clinical practice guidelines in oncology. J Natl Compr Canc Netw 2022; 20(4): 387-405.
[13]
Brown KK, Rajan SK, Shenoy P, et al. The emerging role of mycophenolate mofetil in interstitial lung diseases. Expert Rev Respir Med 2021; 15(12): 1539-49.
[http://dx.doi.org/10.1080/17476348.2021.2001331] [PMID: 34758677]
[http://dx.doi.org/10.1080/17476348.2021.2001331] [PMID: 34758677]
[14]
Izumi H, Kodani M, Kurai J, et al. Nivolumab-induced cholangitis in patients with non-small cell lung cancer: Case series and a review of literature. Mol Clin Oncol 2019; 11(5): 439-46.
[http://dx.doi.org/10.3892/mco.2019.1923] [PMID: 31616560]
[http://dx.doi.org/10.3892/mco.2019.1923] [PMID: 31616560]
[15]
Ueno M, Takabatake H, Hata A, et al. Mycophenolate mofetil for immune checkpoint inhibitor-related hepatotoxicity relapsing during dose reduction of corticosteroid: A report of two cases and literature review. Cancer Rep 2022; 5(9): e1624.
[http://dx.doi.org/10.1002/cnr2.1624] [PMID: 35575047]
[http://dx.doi.org/10.1002/cnr2.1624] [PMID: 35575047]
[16]
Kurokawa M, Shimizu K, Kitabayashi R, et al. Re-administration of pembrolizumab for urothelial carcinoma after immune-related myasthenia gravis : A case report. Hinyokika Kiyo 2022; 68(9): 295-300.
[PMID: 36199208]
[PMID: 36199208]
[17]
Bir Yucel K, Sutcuoglu O, Yazıcı O, Yıldız Y, Şenol E, Uner A. Nivolumab-ipilimumab combination therapy-induced seronegative encephalitis; rapid response to steroid plus intravenous immunoglobulin (IVIG) treatment. J Oncol Pharm Pract 2022; 29(3): 760-3.
[PMID: 35938177]
[PMID: 35938177]