Treatment of mycophenolate-resistant immune-related organizing pneumonia with infliximab

Journal for ImmunoTherapy of Cancer

Alfred Zippelius¹  Guacimara Ortega Sanchez¹  Heinz Läubli¹  Kathleen Jahn²  Spasenija Savic³ 

[1] Department of Internal Medicine, Division of Medical Oncology, University Hospital Basel;Division of Pneumology and Pulmonary Cell Research, University Hospital Basel;Institute of Pathology, University Hospital Basel;

关键词: Immune checkpoint inhibitor;    Cancer immunotherapy;    Pneumonitis;    Lung;    Immune-related adverse event;   

DOI  :  10.1186/s40425-018-0400-4

来源: DOAJ

【 摘 要 】

Abstract Background The development of pulmonary immune-related adverse events (irAEs) in patients undergoing PD-(L)1 targeted checkpoint inhibitors are rare, but may be life-threatening. While many published articles and guidelines are focusing on the presentation and upfront treatment of pulmonary irAEs, the strategy in patients with late-onset pneumonia that are resistant to commonly used immunosuppressive drugs remains unclear. Case presentation Here, we report the successful treatment of a mycophenolate-resistant organizing pneumonia (OP) with infliximab in a patient with metastatic melanoma after PD-1 blockade. The patient received two years of PD-1 targeted immunotherapy when he developed multiple nodular lung lesions mimicking a metastatic progression. However, wedge resection of these lesions showed defined areas of OP, which responded well to corticosteroids. Upon tapering, new foci of OP developed which were resistant to high-dose steroids and mycophenolate treatment. The TNFα antagonist infliximab led to a rapid and durable regression of the inflammatory lesions. Conclusion This case describes a not well-studied situation, in which a mycophenolate-resistant PD-1 blocker-associated pneumonitis was successfully treated with a TNFα neutralizing antibody. The outcome of this case suggests that infliximab might be the preferable option compared to classical immunosuppressants in the case of steroid-resistant/−dependent late onset pulmonary irAEs.

【 授权许可】

Unknown