Particular findings on lung CT in patients undergoing immunotherapy for bronchogenic carcinoma
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Wien Klin Wochenschr https://doi.org/10.1007/s00508-020-01667-0
Particular findings on lung CT in patients undergoing immunotherapy for bronchogenic carcinoma Lucian Beer · Maximilian Hochmair · Daria Kifjak · Alexander R. Haug · Florian Prayer · Marius E. Mayerhoefer · Christian Herold · Helmut Prosch
Received: 13 July 2019 / Accepted: 29 April 2020 © The Author(s) 2020
Summary Background Immune checkpoint inhibitors have become a valuable tool in the therapeutic strategy against metastasized non-small cell lung cancer (NSCLC) as they represent an effective and safe treatment option for many patients; however, the treatment response and side effects of this class of drugs can considerably differ compared to classical chemotherapeutics. The aim of this study was to highlight specific radiological pulmonary findings of NSCLC patients treated with immune checkpoint inhibitors. Methods and results Medical records and images of prospectively collected data from 70 patients with advanced NSCLC, treated with immune checkpoint inhibitors, were reviewed. Of the patients two experienced an initial increase in tumor size, followed by a decrease in tumor size that was described as pseudoprogression. Another patient developed a sarcoidlike reaction accompanied by clinical improvements and radiological treatment response. A further two patients developed immune checkpoint-associated pulmonary injury that was clinically and radiologically
L. Beer, MD, PhD · D. Kifjak · A. R. Haug, MD · F. Prayer, MD · M. E. Mayerhoefer, MD, PhD · C. Herold, MD · H. Prosch, MD () Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria [email protected] L. Beer, MD, PhD Department of Radiology and Cancer Research, UK Cambridge Center, Cambridge, CB2 0QQ, UK M. Hochmair, MD Department of Internal Medicine and Pneumology, Krankenhaus Nord—Klinik Floridsdorf, Vienna, Austria
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classified as pneumonitis, which responded well to anti-inflammatory treatment. Conclusion Management of patients with NSCLC using immune checkpoint inhibitors requires a knowledge of specific clinical and radiological findings. Both oncologists and radiologists have to be aware of the most common types, including atypical response patterns, such as a sarcoid-like reaction and pseudoprogression as well as of the pulmonary side effects that can encompass pneumonitis. Keywords Non-small cell lung cancer · Nivolumab · Radiology · Oncology · PD1 receptor
Introduction Immune checkpoint inhibitors have revolutionized treatment for many cancer patients and enabled tremendous achievements in treatment. In 2015, the first immune checkpoint inhibitor, nivolumab, a targeted programmed death 1 (PD-1)-mediated inhibitor, was approved for patients with advanced non-small cell lung cancer (NSCLC) [1, 2]. Since then, a wealth of immune checkpoint inhibitors have joined nivolumab, including pembrolizumab, atezolizumab, and durvalumab, and have proven their efficacy in NSCLC patients. In the near
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