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Pneumonitis Associated with Immune Checkpoint Inhibitors and Targeted Anticancer Therapies: A Retrospective Case Series of 12 Patients

Year: 2026

Type: article

Abstract: Background: Immunotherapy and targeted therapy have gained ground over conven-tional chemotherapy in treating various cancers. While pulmonary toxicity associated with these agents is rare, it represents a significant factor in both mortality and morbidity and may influence the overall success of cancer treatment. This case series report adds to the emerging evidence of cancer therapy-induced pneumonitis features and cortico-therapy outcomes. Patients and methods: This case series report consists of a retrospective analysis of 12 cases of patients undergoing immunotherapy (4 Nivolumab, 4 Pembrolizumab) or targeted therapy (3 Obinutuzumab, 1 Abemaciclib) for cancer (7 lung, 3 non-Hodgkin lymphoma, 1 breast, 1 renal) that developed pneumonitis during their follow-up. Results: The onset of pneumonitis ranged from 6 to 48 months (median = 18.5), and in 4 cases it occurred after discontinuation of oncologic treatment. The diagnosis was estab-lished with a high probability based only on clinical picture, radiologic features, and concomitant oncologic therapy. The cases with onset after discontinuation of oncologic treatment required a more thorough investigation (including bronchoscopy with BAL analysis). The main symptom was dyspnea (10/12 cases), and 3 of 12 patients had res-piratory failure (SpO2≤88%). The CTCAE severity grades were: 1 mild, 7 moderate, 3 severe, and 1 life-threatening. The CT scan showed different patterns (7 OP, 4 NSIP, and 1 HP). 11 patients received oral methylprednisolone (0.40 to 0.82 mg/kg) for 5 to 16 weeks. 2 patients continued oncologic treatment, and 6 discontinued. All patients showed fa-vorable outcomes. Conclusions: Immunotherapy and targeted therapy-induced pneumonitis can express various features and severities, and prompt recognition and diagnosis based on clinical, radiologic and contextual elements is mandatory. Corticotherapy regimens used, based on severity and treatment response, had a favorable outcome. The follow-up can consist only of clinical assessment and chest X-ray, and extensive tests are reserved for non-responsive cases.

Source: Diseases

DOI: 10.3390/diseases14090313