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01-12-2020 | NSCLC | Minireview

Radiation recall pneumonitis induced by PD-1/PD-L1 blockades: mechanisms and therapeutic implications

Authors: Feifei Teng, Min Li, Jinming Yu

Published in: BMC Medicine | Issue 1/2020

Abstract

Background

The synergistic effect of radiotherapy (RT) in combination with immunotherapy has been shown in several clinical trials and case reports. The overlapping pulmonary toxicity induced by thoracic RT and programmed death 1/programmed death ligand-1 (PD-1/PD-L1) blockades is an important issue of clinical investigation in combination treatment. Thus far, the underlying mechanism of this toxicity remains largely unknown.

Main text

In this review, we discuss the unique pattern of radiation recall pneumonitis (RRP) induced by PD-1 blockade. The clinical presentation is different from common radiation pneumonitis (RP) or RRP induced by cytotoxic drugs. The immune checkpoint inhibitors may evoke an inflammatory reaction in patients’ previously irradiated fields, with infiltrating lymphocytes and potential involvement of related cytokines. All RRP patients have showed durable response to anti-PD-1/PD-L1. RRP is manageable; however, interruption of checkpoint blockades is necessary and immunosuppressive treatment should be started immediately. Further analyses of the predictive factors, including RT dosimetric parameters, tumor-infiltrating lymphocytes (TILs), and PD-L1 expression, are needed given the wide use of immune checkpoint inhibitors and high mortality from lung toxicity with the combination treatment.

Conclusion

Immune checkpoint inhibitors may evoke an RRP in the patients’ previously irradiated fields. Interactions between immune checkpoint inhibitors and radiotherapy should be studied further.

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Title: Radiation recall pneumonitis induced by PD-1/PD-L1 blockades: mechanisms and therapeutic implications
Authors: Feifei Teng
Min Li
Jinming Yu
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: NSCLC
Lung Cancer
Lung Cancer
NSCLC
Radiotherapy
Lung Cancer
Checkpoint Inhibitors
Published in: BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-020-01718-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiation recall pneumonitis induced by PD-1/PD-L1 blockades: mechanisms and therapeutic implications

Abstract

Background

Main text

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Main text

Conclusion

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