Immune-related (IR)-pneumonitis during the COVID-19 pandemic: multidisciplinary recommendations for diagnosis and management

J Immunother Cancer. 2020 Jun;8(1):e000984. doi: 10.1136/jitc-2020-000984.

Abstract

Immune-related (IR)-pneumonitis is a rare and potentially fatal toxicity of anti-PD(L)1 immunotherapy. Expert guidelines for the diagnosis and management of IR-pneumonitis include multidisciplinary input from medical oncology, pulmonary medicine, infectious disease, and radiology specialists. Severe acute respiratory syndrome coronavirus 2 is a recently recognized respiratory virus that is responsible for causing the COVID-19 global pandemic. Symptoms and imaging findings from IR-pneumonitis and COVID-19 pneumonia can be similar, and early COVID-19 viral testing may yield false negative results, complicating the diagnosis and management of both entities. Herein, we present a set of multidisciplinary consensus recommendations for the diagnosis and management of IR-pneumonitis in the setting of COVID-19 including: (1) isolation procedures, (2) recommended imaging and interpretation, (3) adaptations to invasive testing, (4) adaptations to the management of IR-pneumonitis, (5) immunosuppression for steroid-refractory IR-pneumonitis, and (6) management of suspected concurrent IR-pneumonitis and COVID-19 infection. There is an emerging need for the adaptation of expert guidelines for IR-pneumonitis in the setting of the global COVID-19 pandemic. We propose a multidisciplinary consensus on this topic, in this position paper.

Keywords: autoimmunity; guidelines as topic; immunotherapy.

MeSH terms

  • Antineoplastic Agents, Immunological / adverse effects*
  • B7-H1 Antigen / antagonists & inhibitors
  • B7-H1 Antigen / immunology
  • Betacoronavirus / immunology*
  • Consensus
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / transmission
  • Coronavirus Infections / virology
  • Humans
  • Infectious Disease Medicine / standards
  • Interdisciplinary Communication
  • Lung / diagnostic imaging
  • Lung / drug effects
  • Lung / immunology
  • Medical Oncology / standards
  • Neoplasms / drug therapy
  • Neoplasms / immunology
  • Pandemics / prevention & control*
  • Pneumonia / chemically induced
  • Pneumonia / diagnosis
  • Pneumonia / immunology
  • Pneumonia / therapy*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / transmission
  • Pneumonia, Viral / virology
  • Practice Guidelines as Topic*
  • Pulmonary Medicine / standards
  • Radiology / standards
  • United States / epidemiology

Substances

  • Antineoplastic Agents, Immunological
  • B7-H1 Antigen
  • CD274 protein, human

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2