Pneumonitis from immune checkpoint inhibitors and COVID-19: current concern in cancer treatment

Ernesto Rossi; Giovanni Schinzari; Giampaolo Tortora

doi:10.1136/jitc-2020-000952

Pneumonitis from immune checkpoint inhibitors and COVID-19: current concern in cancer treatment

J Immunother Cancer. 2020 Jul;8(2):e000952. doi: 10.1136/jitc-2020-000952.

Authors

Ernesto Rossi¹, Giovanni Schinzari^{2

3}, Giampaolo Tortora^{2

3}

Affiliations

¹ Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy [email protected].
² Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³ Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.

Abstract

Pneumonitis is a rare but serious adverse event caused by cancer immunotherapy. The diagnosis between COVID-19-induced pneumonia and immunotherapy-induced pneumonitis may be challenging in the era of COVID-19 outbreak. Some clinical symptoms and radiological findings of pneumonitis can be attributed to the coronavirus infection as well as to an immune-related adverse event. Identifying the exact cause of a pneumonitis in patients on treatment with immunotherapy is crucial to promptly start the most appropriate treatment. The proper management of immune checkpoint inhibitors for the risk of pneumonia must take into account a series of parameters. Accurate attention should be payed to symptoms like cough, fever and dyspnea during immunotherapy.

Keywords: CTLA-4 Antigen; cytokines; immunotherapy; melanoma; programmed cell death 1 receptor.

MeSH terms

Antineoplastic Agents, Immunological / adverse effects*
Betacoronavirus
COVID-19
COVID-19 Testing
CTLA-4 Antigen / antagonists & inhibitors
Clinical Laboratory Techniques
Coronavirus Infections / diagnosis*
Coronavirus Infections / immunology
Coronavirus Infections / therapy
Diagnosis, Differential
False Negative Reactions
Glucocorticoids / therapeutic use
Humans
Immunosuppressive Agents / therapeutic use
Lung / diagnostic imaging
Neoplasms / drug therapy*
Pandemics
Pneumonia / chemically induced*
Pneumonia / diagnosis*
Pneumonia / drug therapy
Pneumonia / immunology
Pneumonia, Viral / diagnosis*
Pneumonia, Viral / immunology
Pneumonia, Viral / therapy
Programmed Cell Death 1 Receptor / antagonists & inhibitors
Reverse Transcriptase Polymerase Chain Reaction
SARS-CoV-2
Tomography, X-Ray Computed

Substances

Antineoplastic Agents, Immunological
CTLA-4 Antigen
CTLA4 protein, human
Glucocorticoids
Immunosuppressive Agents
PDCD1 protein, human
Programmed Cell Death 1 Receptor