Targeted therapy against PD-1 can be used in a number of cancers that have failed routine therapy. However, therapy with anti-PD-1 agents can result in an autoimmune pneumonitis.
Anti-PD-1 agents block checkpoints in inhibitory T-cells, in theory allowing a cellular immune response against the tumor.
Tumors treated with anti-PD-1 agents include:
(1) squamous cell carcinoma of the lung
(2) melanoma
(3) renal cell carcinoma
Some patients with develop an autoimmune pneumonitis that results in an interstitial pneumonia that can progress to ARDS and respiratory failure.
Management includes:
(1) discontinuation of the anti-PD-1 agent
(2) initiation of therapy with corticosteroids
(3) therapy with infliximab
(4) exclusion of infectious or other causes
(5) ventilatory support
(6) close monitoring, often in the ICU
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