Imaging features of toxicities associated with immune checkpoint inhibitors

Babina Gosangi; Lacey McIntosh; Abhishek Keraliya; David Victor Kumar Irugu; Akshay Baheti; Ashish Khandelwal; Richard Thomas; Marta Braschi-Amirfarzan

doi:10.1016/j.ejro.2022.100434

Imaging features of toxicities associated with immune checkpoint inhibitors

Eur J Radiol Open. 2022 Aug 8:9:100434. doi: 10.1016/j.ejro.2022.100434. eCollection 2022.

Authors

Babina Gosangi¹, Lacey McIntosh², Abhishek Keraliya³, David Victor Kumar Irugu⁴, Akshay Baheti⁵, Ashish Khandelwal⁶, Richard Thomas⁷, Marta Braschi-Amirfarzan⁷

Affiliations

¹ Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
² Department of Radiology, University of Massachusetts, Worcester, MA, USA.
³ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Magnus Hospital, Hyderabad, India.
⁵ Tata Memorial Hospital, Mumbai, India.
⁶ Department of Radiology, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Radiology, Lahey Health System, Burlington, MA, USA.

Abstract

The past decade has witnessed a change in landscape of cancer management with the advent of precision oncology. Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and have played an important role in improving patient survival. While the patients are living longer, treatment with ICIs are sometimes associated with adverse effects, some of which could be fatal. Radiologists can play a crucial role by early identification of some of these adverse effects during restaging scans. Our paper focuses on the imaging features of commonly occurring ICI toxicities based on organ system.

Keywords: AIP, acute interstitial pneumonitis; ARDS, acute respiratory distress syndrome; CTCAE, Common Terminology Criteria for Adverse Events; CTLA-4 inhibitor, Cytotoxic T-lymphocyte antigen- 4 inhibitor; Colitis; FDA, Food and Drug Administration; Hepatitis; ICI, Immune check point inhibitor; Immune check point inhibitors toxicity; LGE, late Gadolinium enhancement; NSCLC, non-small cell lung cancer; NSIP, non-specific interstitial pneumonia; OP, organizing pneumonia; PD-1 inhibitor, programmed cell death-1 inhibitor; PD-L1 inhibitor, programmed cell death ligand-1 inhibitor; PFS, progression free survival; Pancreatitis; Pneumonitis; RRP, radiation recall pneumonitis; irAE, immune-related adverse event.