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    Patent Pending

    Immune-Related Adverse Events for Lung Toxicity - Pneumonitis

    Grades severity of pneumonitis secondary to immune checkpoint inhibitor therapy.

    INSTRUCTIONS

    Use in adult patients with symptoms of pneumonitis or focal or diffuse inflammation of the lung parenchyma typically identified on CT imaging while on treatment with immune checkpoint inhibitors.

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients with symptoms of pneumonitis (cough, wheezing, fatigue, chest pain) or focal or diffuse inflammation of the lung parenchyma while on treatment with immune checkpoint inhibitors including agents against PD-1 (i.e., pembrolizumab, nivolumab), PD-L1 (i.e., atezolizumab, avelumab, durvalumab), or CTLA-4 (i.e., ipilimumab).

    • Immune checkpoint inhibitor (ICPi) pneumonitis should be suspected in patients with symptoms of pneumonitis (cough, wheezing, fatigue, chest pain) or those with focal or diffuse inflammation of the lung parenchyma, typically identified on CT imaging while on treatment with immune checkpoint inhibitors.

    • Immune checkpoint inhibitor (ICPi) pneumonitis is an uncommon but potentially serious toxicity. 

    • May occur any time during immune checkpoint inhibitor treatment with a range of 2-24 months. Median time to onset is approximately 3 months. 

    • More frequently seen with anti-PD1 agents, but is also an important adverse event caused by anti-CTLA-4 agents.

    • Management of immune checkpoint inhibitor pneumonitis is based on the grade of pneumonitis.

    ICPi pneumonitis is a rare but potentially life threatening toxicity of immune checkpoint inhibitors. This tool aids in the decision to discontinue ICPI, further diagnostic work-up and immunosuppressant treatment initiation.

    Asymptomatic, confined to one lobe of the lung or <25% of lung parenchyma, clinical, or diagnostic observations only
    Symptomatic, involves more than one lobe of the lung or 25-50% of lung parenchyma, medical intervention indicated, limiting instrumental ADL
    Severe symptoms, hospitalization required, involves all lung lobes or >50% of lung parenchyma, limiting self-care ADL, oxygen indicated
    Life-threatening respiratory compromise, urgent intervention indicated (intubation)

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    Evidence
    Creator Insights
    Dr. Julie R. Brahmer

    About the Creator

    Julie R. Brahmer, MSc, MD, is the co-director of the upper aerodigestive department at Johns Hopkins Medicine in Baltimore, MD. She is also a professor of oncology at Johns Hopkins Medicine. Dr. Brahmer’s primary research is focused on treatment of lung cancer and mesothelioma.

    To view Dr. Julie R. Brahmer's publications, visit PubMed

    Are you Dr. Julie R. Brahmer? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Nazli Dizman, MD
    About the Creator
    Dr. Julie R. Brahmer
    Are you Dr. Julie R. Brahmer?
    Content Contributors
    • Nazli Dizman, MD