[Can nivolumab be used safely in idiopathic pulmonary fibrosis?]

Rev Mal Respir. 2019 Feb;36(2):209-213. doi: 10.1016/j.rmr.2018.11.001. Epub 2019 Jan 24.
[Article in French]

Abstract

Anti-PD1 immunotherapies have become an essential treatment for bronchial cancer. According to published studies, PD1 and PD-L1 inhibitors have a better toxicity profile than chemotherapy. Nevertheless, some immune related toxicities can be potentially severe, such as induced interstitial lung disease (ILD). Currently, ILD patients are excluded from clinical trials using immunotherapy in lung cancer. IPF is the most frequent and severe form of ILD. Lung cancer represents a major complication of this disease and to date few data exist on the safety of immunotherapy in this context. We report 3 cases of IPF with lung cancer treated by nivolumab. All had a clinically mild to moderate IPF. The patients had received at least one line of chemotherapy before nivolumab and had progressive, metastatic lung cancer. Two patients experienced rapid cancer progression without immune toxicities. The third had a partial response but developed grade III immune colitis that led to discontinuation of the treatment. None developed lung toxicity or worsening of IPF on CT during follow-up, and death was always related to progression of the cancer. In our series of three patients with IPF, nivolumab was well tolerated with regard to their pulmonary condition. As inflammation and autoimmunity are probably marginal mechanisms in the pathogenesis of IPF, we do not believe that the presence of IPF should definitely disqualify potential candidates for treatment with nivolumab. Decisions should be taken, case-by-case, in selected patients without severe IPF and with no evidence of autoimmunity. In view of the epidemiology of lung cancer in IPF and the critical role of immunotherapy in the management of lung cancer, studies of prospective cohorts are urgently needed in this population.

Keywords: Anti-PD1; Cancer bronchique; Fibrose pulmonaire idiopathique; IPF; Immunotherapy; Immunothérapie; Lung cancer; Nivolumab; PD1 inhibitor.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma of Lung / complications
  • Adenocarcinoma of Lung / drug therapy
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / drug therapy
  • Colitis / chemically induced
  • Colitis / diagnosis
  • Colitis / immunology
  • Comorbidity
  • Disease Progression
  • Humans
  • Idiopathic Pulmonary Fibrosis / complications
  • Idiopathic Pulmonary Fibrosis / drug therapy*
  • Idiopathic Pulmonary Fibrosis / pathology
  • Immunotherapy / adverse effects*
  • Immunotherapy / methods
  • Lung Neoplasms / complications
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / pathology
  • Male
  • Nivolumab / adverse effects
  • Nivolumab / therapeutic use*

Substances

  • Nivolumab