The incidence of ICI-induced pulmonary toxicity ranges from 2.7% to 11% for all grades and has a median onset time of 8 to 12 weeks after initiating therapy. Although the incidence is lower than other more common irAEs, it has a poor prognosis and often results in delay or discontinuation of ICIs. An increased prevalence of pulmonary dysfunction is seen in those patients receiving combination vs. monotherapy. In addition, non-small cell lung cancer (NSCLC) patients tend to be at a higher risk for developing and having earlier onset of pulmonary toxicity than other cancer subtypes. Diagnosis is challenging due to non-specific symptoms including chest pain, difficulty breathing, cough and occasionally fever. Therefore, high resolution diagnostic imaging and pulmonary function tests are highly recommended.
Inflammation of the lungs is the most common lung toxicity among patients receiving ICIs, with an estimated overall incidence of 2.7% to 5%. Pneumonitis usually presents within the first 12 weeks of treatment initiation and if not diagnosed and treated early can have poor clinical outcomes. The most common symptoms include new onset respiratory distress, difficulty breathing and cough. Clinical assessment includes diagnostic imaging, functional assessment, serum testing, and elimination of alternative diagnoses. Although most patients experience grade 1-2 pneumonitis, it can rapidly escalate to a grade 3-4 irAE with a high mortality rate (50%-60%). The optimal treatment regimen has yet to be established, however the recommendations based on the grade are listed in table below.
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