Risk factors for and characteristics of pneumonitis in patients treated with anti-programmed death-1 therapy.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 128-128
Author(s):  
YI HU ◽  
Pengfei Cui ◽  
Jing Zhang
Keyword(s):  
Risk Factors ◽  
Combination Therapy ◽  
Clinical Features ◽  
Steroid Therapy ◽  
Low Grade ◽  
Thoracic Radiotherapy ◽  
Programmed Death ◽  
Lung Condition ◽  
History Of ◽  
Programmed Death 1

128 Background: Pneumonitis is an uncommon but potentially fatal toxicity of anti–programmed death-1 (PD-1) monoclonal antibodies (mAbs), but its prevalence, risk factors and clinical features are poorly described. Methods: The medical records of 234 patients with advanced cancer who underwent anti–PD-1mAbs therapies between September 2015 and September 2017 at the Cancer Center of the Chinese PLA (People’s Liberation Army) General Hospital were analyzed with regard to patient background and clinical features. Pneumonitis was diagnosed by the treating investigator; cases with confirmed malignant lung infiltration or infection were excluded. Univariate and multivariate analyses were performed to identify independent predictive factors for pneumonitis. Clinical features, management and prognosis of pneumonitis were also collected. Results: A total of 55 patients (23.5%) developed pneumonitis. Anti–PD-1mAbs induced pneumonitis was significantly associated with male sex, a history of prior thoracic radiotherapy, combination therapy and underlying lung condition (odds ratios 3.380, 3.081, 2.538 and 2.559, respectively). Time to onset of pneumonitis ranged from 2 days to 277days (median time was 85days). 85.4% (47 of 55) of cases were grade 1 to 2, 25.5% (14 of 55) were treated with steroid therapy, of which 85.7% (12 of 14) resolved/ improved. Nine (16.4%) patients worsened clinically and one died during the course of pneumonitis treatment. Conclusions: Pneumonitis associated with anti–PD-1 mAbs is a serious adverse effect in the clinical setting that cannot be ignored. However, patient selection based on sex, history of prior thoracic radiotherapy, combination therapy and underlying lung condition can minimize pneumonitis risk. Most events are low grade and resolved/ improved with steroid therapy. Rarely, pneumonitis worsens despite steroid therapy, and may result in death.

Giant cell arteritis associated with PD-1 inhibition

2021 ◽  
Vol 14 (11) ◽  
pp. e246443
Author(s):  
Nina Couette ◽  
Jisna Paul
Keyword(s):  
Malignant Disease ◽  
Temporal Artery ◽  
Steroid Treatment ◽  
Antagonist Therapy ◽  
Programmed Death ◽  
Metastatic Lung ◽  
History Of ◽  
Steroid Side Effects ◽  
Programmed Death 1 ◽  
New Onset

A 50-year-old woman was referred to rheumatology for new onset polyarthralgia and headache. She had a history of metastatic lung adenocarcinoma and was started on treatment with the programmed death 1 receptor (PD-1) antagonist pembrolizumab 2 months prior. Examination revealed left temporal artery tenderness and hand synovitis. Investigations revealed enlarged temporal artery on ultrasound imaging. On steroid treatment, she had resolution of symptoms, but due to significant steroid side effects required methotrexate and her PD-1 antagonist therapy was continued in consultation with her oncologist. Her malignant disease has remained stable, and she has improved functional status.

scholarly journals A case report of psoriasis flare following immunotherapy: Report of an important entity and literature review

2020 ◽  
Vol 8 ◽  
pp. 2050313X1989770 ◽  
Author(s):  
Anastasia Politi ◽  
Dimas Angelos ◽  
Davide Mauri ◽  
George Zarkavelis ◽  
George Pentheroudakis
Keyword(s):  
Adverse Events ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Skin Lesions ◽  
Inflammatory Disorder ◽  
Immune Mediated ◽  
Programmed Death ◽  
History Of ◽  
Programmed Death 1 ◽  
Cessation Of Treatment

Immune checkpoint inhibitors, such as anti-cytotoxic T-lymphocyte–associated antigen-4 and anti-programmed death-1, are a type of cancer immunotherapy approved for late-stage malignancy treatment. However, such therapies often induce immune-related adverse events. During anti-programmed death-1 blockade therapy, the most commonly reported adverse effects are skin toxicities, such as psoriasis—a chronic immune-mediated inflammatory disorder affecting the skin. We present the clinical characteristics of flared psoriasis in one patient under anti-programmed death-1 therapy who was diagnosed with T2N2M0/IIIB squamous lung carcinoma with a history of psoriasis for the past 5 years, exacerbated after the first cycle of nivolumab. After the third cycle, the extensive skin plaques necessitated treatment cessation. Following the discontinuation of anti-programmed death-1 treatment, skin lesions were treated locally. Possibly, anti-programmed death-1 immunotherapy can trigger immune-mediated diseases, such as psoriasis. Physicians should be alert to immune-related adverse events. Continuation or permanent cessation of treatment depends on the severity and reversibility of immune-related adverse events.

Clinical Features and Risk Factors of Parkinson’s Disease in a Population of Khyber Pakhtunkhwa, Pakistan: A Case-Control Study

2019 ◽  
Vol 19 (5-6) ◽  
pp. 211-217
Author(s):  
Muhammad Tufail
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Features ◽  
Case Control Study ◽  
Case Control ◽  
Khyber Pakhtunkhwa ◽  
History Of ◽  
The Government ◽  
Control Study

Background: Parkinson’s disease (PD) is one of the most common neurological disorders that mostly affect aged individuals. The common symptoms of PD are rest tremor, bradykinesia, and rigidity. Objectives: The present study was devised to find out the clinical features and risk factors associated with PD in a population of Khyber Pakhtunkhwa. Methods:A total of 600 PD patients and 1,200 control individuals took part in this study. The participants filled out a standard questionnaire. Results: This study found a significant association between PD and exposure to pesticides (p < 0.0001) and doing work on farms (p < 0.0001). The use of aldrin was significantly associated with PD (p < 0.0001). Furthermore, we also found that PD status was associated with individuals who have a history of depression, hypertension, head injury, and Alzheimer’s disease. This study also showed that the PD rate was lower in those who were using tobacco products. Conclusion: In this case-control study, we revealed some environmental and medical conditions that are linked with PD. To control the disease, we must minimize exposure to pesticides, and the government and scientific community should play their role.

Observational study of ifosfamide (Ifos) neurotoxicity (N): The prospective use of a nursing assessment tool.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19580-e19580
Author(s):  
Jeanne Held-Warmkessel ◽  
Monica Davey ◽  
Samuel Litwin ◽  
John Lee ◽  
Mitchell Reed Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Assessment Tool ◽  
Signs And Symptoms ◽  
Well Being ◽  
Prior History ◽  
Low Grade ◽  
Nursing Assessment ◽  
History Of ◽  
Hand Writing ◽  
Writing Sample

e19580 Background: Ifos chemotherapy is known to cause central nervous system toxicity. Risk factors have not been well identified in the literature, with limited information on the onset, duration, and severity of this toxicity. No clinical tools are available to assess and document N. Methods: We developed a clinical nursing assessment tool based upon review of the literature. Patients initiating inpatient Ifos chemotherapy, after informed consent was obtained under an IRB approved protocol, were prospectively monitored for signs and symptoms of N during 1 cycle of therapy. A full neurologic nursing assessment of 24 signs and symptoms including a hand writing sample was done at baseline and a basic assessment evaluating alertness, orientation, sense of well being and a hand writing sample was repeated every 12 hours. In the event N was identified, a full assessment was repeated; observed N was graded using the NCI CTC, version 3. Other variables collected were demographic traits, dose per day, hydration, and potential risk factors for N: renal function, albumin, largest pelvic tumor dimension, prior Ifos or cisplatin, use of other medications with potential for N, and alcohol use history. Individual factors were analyzed using Fisher’s exact test or the Wilcoxon two-sample test. Results: Eighty patients were accrued from 5/09-1/12. Median age was 54.5 (range: 21-85), 51% were males, PS 0 in 26.3%, 1 in 65%, 2 in 6.3% and 3 or 4 in 1.3% each. Diagnosis was sarcoma in 73.75%, lymphoma 22.5%, or germ cell tumor 3.75%. N was observed in 47.5% of patients. Toxicities in >15% of patients were sleepiness (25%), lethargy and restlessness (16.25% for each), and dizziness (15%). The majority were grade 1-2 (89.6%). Factors associated with N included generic versus brand formulation of Ifos (p=0.041) and prior history of a drug related neurotoxicity (p=0.047). BSA, performance status, gender, age, dose per m2, total planned dose, pretreatment Cr, and pretreatment albumin were not associated. Conclusions: The incidence of Ifos N is common using this nursing assessment tool, although usually low grade. We identified the formulation of Ifos and a prior history of drug related N as statistically correlated with developing N.

Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: A retrospective study

2015 ◽  
Vol 183 ◽  
pp. 339-346 ◽  
Author(s):  
Fuzhong Yang ◽  
Charles O. Gardner ◽  
Tim Bigdeli ◽  
Jingfang Gao ◽  
Zhen Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Major Depression ◽  
Clinical Features ◽  
Chinese Women ◽  
Han Chinese ◽  
History Of

scholarly journals Risk factors for pneumonitis in patients treated with anti-programmed death-1 therapy: A case-control study

2018 ◽  
Vol 7 (8) ◽  
pp. 4115-4120 ◽  
Author(s):  
Pengfei Cui ◽  
Zhefeng Liu ◽  
Guoqiang Wang ◽  
Junxun Ma ◽  
Yuanyu Qian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Case Control ◽  
Programmed Death ◽  
Programmed Death 1 ◽  
Control Study

scholarly journals Early versus late acute kidney injury among patients with COVID-19—a multicenter study from Wuhan, China

2020 ◽  
Vol 35 (12) ◽  
pp. 2095-2102
Author(s):  
Suyuan Peng ◽  
Huai-Yu Wang ◽  
Xiaoyu Sun ◽  
Pengfei Li ◽  
Zhanghui Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Clinical Features ◽  
Kidney Injury ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Tertiary Hospitals ◽  
History Of

Abstract Background Acute kidney injury (AKI) is an important complication of coronavirus disease 2019 (COVID-19), which could be caused by both systematic responses from multi-organ dysfunction and direct virus infection. While advanced evidence is needed regarding its clinical features and mechanisms. We aimed to describe two phenotypes of AKI as well as their risk factors and the association with mortality. Methods Consecutive hospitalized patients with COVID-19 in tertiary hospitals in Wuhan, China from 1 January 2020 to 23 March 2020 were included. Patients with AKI were classified as AKI-early and AKI-late according to the sequence of organ dysfunction (kidney as the first dysfunctional organ or not). Demographic and clinical features were compared between two AKI groups. Their risk factors and the associations with in-hospital mortality were analyzed. Results A total of 4020 cases with laboratory-confirmed COVID-19 were included and 285 (7.09%) of them were identified as AKI. Compared with patients with AKI-early, patients with AKI-late had significantly higher levels of systemic inflammatory markers. Both AKIs were associated with an increased risk of in-hospital mortality, with similar fully adjusted hazard ratios of 2.46 [95% confidence interval (CI) 1.35–4.49] for AKI-early and 3.09 (95% CI 2.17–4.40) for AKI-late. Only hypertension was independently associated with the risk of AKI-early. While age, history of chronic kidney disease and the levels of inflammatory biomarkers were associated with the risk of AKI-late. Conclusions AKI among patients with COVID-19 has two clinical phenotypes, which could be due to different mechanisms. Considering the increased risk for mortality for both phenotypes, monitoring for AKI should be emphasized during COVID-19.

scholarly journals Pneumonitis in Patients Treated With Anti–Programmed Death-1/Programmed Death Ligand 1 Therapy

2017 ◽  
Vol 35 (7) ◽  
pp. 709-717 ◽  
Author(s):  
Jarushka Naidoo ◽  
Xuan Wang ◽  
Kaitlin M. Woo ◽  
Tunc Iyriboz ◽  
Darragh Halpenny ◽  
...  
Keyword(s):  
T Cell ◽  
Cytotoxic T Cell ◽  
Cancer Center ◽  
Low Grade ◽  
Programmed Death Ligand 1 ◽  
Exact Test ◽  
Underlying Malignancy ◽  
Programmed Death ◽  
Pathologic Features ◽  
Programmed Death 1

Purpose Pneumonitis is an uncommon but potentially fatal toxicity of anti–programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1) monoclonal antibodies (mAbs). Clinical, radiologic, and pathologic features are poorly described. Methods Patients who received anti–PD-1/PD-L1 monotherapy or in combination with anti–cytotoxic T-cell lymphocyte associated antigen-4 mAb were identified at two institutions (Memorial Sloan Kettering Cancer Center: advanced solid cancers, 2009 to 2014, and Melanoma Institute of Australia: melanomas only, 2013 to 2015). Pneumonitis was diagnosed by the treating investigator; cases with confirmed malignant lung infiltration or infection were excluded. Clinical, radiologic, and pathologic features of pneumonitis were collected. Associations among pneumonitis incidence, therapy received, and underlying malignancy were examined with Fisher’s exact test as were associations between pneumonitis features and outcomes. Results Of 915 patients who received anti–PD-1/PD-L1 mAbs, pneumonitis developed in 43 (5%; 95% CI, 3% to 6%; Memorial Sloan Kettering Cancer Center, 27 of 578 [5%]; Melanoma Institute of Australia, 16 of 337 [5%]). Time to onset of pneumonitis ranged from 9 days to 19.2 months. The incidence of pneumonitis was higher with combination immunotherapy versus monotherapy (19 of 199 [10%] v 24 of 716 [3%]; P < .01). Incidence was similar in patients with melanoma and non–small-cell lung cancer (overall, 26 of 532 [5%] v nine of 209 [4%]; monotherapy, 15 of 417 v five of 152 [ P = 1.0]; combination, 11 of 115 v four of 57 [ P = .78]). Seventy-two percent (31 of 43) of cases were grade 1 to 2, and 86% (37 of 43) improved/resolved with drug holding/immunosuppression. Five patients worsened clinically and died during the course of pneumonitis treatment; proximal cause of death was pneumonitis (n = 1), infection related to immunosuppression (n = 3), or progressive cancer (n = 1). Radiologic and pathologic features of pneumonitis were diverse. Conclusion Pneumonitis associated with anti–PD-1/PD-L1 mAbs is a toxicity of variable onset and clinical, radiologic, and pathologic appearances. It is more common when anti–PD-1/PD-L1 mAbs are combined with anti–cytotoxic T-cell lymphocyte associated antigen-4 mAb. Most events are low grade and improve/resolve with drug holding/immunosuppression. Rarely, pneumonitis worsens despite immunosuppression, and may result in infection and/or death.

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