Philippe Camus, M.D.

Dijon, France

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The Drug-Induced Respiratory Disease Website

Immune checkpoint inhibitors (ICI) - ICI combinatorial Rx

The manifold possible adverse effects from ICI in varied organs must be checked in every patient receiving these medications. AEs tend to occur with higher frequency with combo theray than when these agent are taken in isolation. Anti CTLA-4, anti-CD52, anti-PD1, anti-PDL-1 antibodies (PMID 23714523, 24904570, 25776466). For review of pulmonary and nonpulmonary AEs, and management guidelines see under PMID 26371282, 29442540. Can be fatal (PMID: 29735504). For review see PMID 32158597).

I - Cardiac arrhythmia(s)/dysrhythmia(s) (AF, VT, VF, TdP) - QTc prolongation)

I.a

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)
I.m

Sudden cardiac death

II - Myocardial dysfunction - Heart failure

II.a

Left ventricular dysfunction/failure
II.c

Heart failure (biventricular, congestive)
II.d

Cardiovascular collapse - Cardiogenic shock - Hypotension

III - Myocardial ischemia - Coronary artery disease

III.a

Coronary artery disease (acute) - Myocardial ischemia/infarction

IV - Heart block (bundle branch-, AV-block)

IV.a

Heart block (bundle branch- or AV-)

V - Myocarditis

V.a

Myocarditis (can be fulminate/fulminant)
V.e

Necrotizing myocarditis (w/o evidence for CAD)

VI - Cardiomyopathy

VI.c

Takotsubo (stress) cardiomyopathy

VII - Cardiotoxicity

VII.a

‘Cardiotoxicity’

X - Pulmonary edema

X.a

Pulmonary edema, cardiogenic

XI - Pulmonary vasculopathies

XI.a

Pulmonary arterial hypertension

XII - Pericardial involvement

XII.b

Pericardial effusion (w/wo tamponade)

XIII - Thrombosis - Embolism

XIII.a

Pulmonary embolism - Venous thrombosis/thrombo-embolism

XIV - Pleural involvement

XIV.a

Pleural effusion (uni or bilateral) (can accompany ILD induced by the drug)
XIV.i

Serositis - Polyserositis

XV - Chest pain

XV.e

Pleuritis (can cause chest pain)

XVI - Hemorrhage - Bleeding - Hematoma(s)

XVI.h

Coagulopathy

XXI - Mediastinal involvement/injury

XXI.a

Lymphadenopathy (intrathoracic)

XXII - Acute respiratory/cardiorespiratory failure

XXII.b

Acute lung injury - ARDS

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.a

Pneumonitis (ILD)
XXIV.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)
XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
XXIV.d

Acute eosinophilic pneumonia (AEP)
XXIV.e

Relapsing or migrating pneumonitis/pneumonia (see also Id)
XXIV.h

Pulmonary fibrosis (may improve but partly following drug discontinuation)
XXIV.i

Progression, acceleration or exacerbation of preexisting ILD/fibrosis
XXIV.j

Organizing pneumonia (OP/BOOP) pattern (an area or areas of consolidation on imaging)
XXIV.l

Acute fibrinous organizing pneumonia (AFOP)
XXIV.o

Rapidly progressive ILD/pulmonary fibrosis (Hamman-Rich syndrome)
XXIV.q

Delayed ILD, -pneumonitis, -fibrosis
XXIV.v

Radiation recall pneumonitis
XXIV.ab

Chronic pneumonitis/ILD
XXIV.ac

Shrinking lung syndrome

XXIX - Small airway involvement

XXIX.a

Bronchospasm - Wheezing - Asthma
XXIX.i

Exacerbation or deterioration of preexisting COPD

XXX - Imaging features

XXX.h

Imaging: Avid pleural uptake on PET-scan

XXXIII - Histopathology (for pulmonary pathology see in ‘Pneumotox’ (a free companion App)

XXXIII.f

Path: Myocardial vasculitis

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.f

Anaphylaxis - Anaphylactoid reaction (either of these can be fatal)
XXXVI.q

Tumor lysis syndrome (TLS)
XXXVI.v

Temporal arteritis (Horton’s)