Clinical features and management of steroid-refractory ICI-pneumonitis by immunosuppressive treatment
| Therapy type | Intravenous immunoglobulin | Infliximab | Combination |
| Total patients, n (%) | 7 | 2 | 3 |
| Steroid-refractory pneumonitis features | |||
| Initial CTCAE grade | |||
| 2 | 3 (43) | 0 (0) | 0 (0) |
| 3 | 4 (57) | 2 (100) | 3 (100) |
| ICI doses (mean, range) | 5 (3–10) | 7 (1–13) | 2 (2–3) |
| ICI start to steroid-refractory pneumonitis onset, days (mean, range) | 127 (39–208) | 98 (14–182) | 40 (21–77) |
| Hospital length of stay, days (mean, range) | 21 (6–48) | 13.5 (13–14) | 20 (8–31) |
| Steroid-refractory pneumonitis management | |||
| Corticosteroid duration, days (mean, range) | 59 (14–122) | 58 (19–97) | 26 (5–41) |
| First corticosteroid dose to first immunosuppression dose, days (mean, range) | 17 (2–96) | 8 (4–12) | 2 (1–5) |
| Intubation for SRCIP | 1 (14) | 1 (50) | 1 (33) |
| Diagnostic bronchoscopy with bronchoalveolar lavage | 4 (57) | 1 (50) | 1 (33) |
| Pulmonology consult | 7 (100) | 2 (100) | 3 (100) |
| Infectious disease consult | 4 (57) | 1 (50) | 2 (67) |
| Steroid-refractory pneumonitis outcomes | |||
| CTCAE grade after immunosuppression | |||
| 2 | 3 (43) | 0 (0) | 0 (0) |
| 3 | 3 (43) | 1 (50) | 2 (67) |
| 4 | 1 (14) | 1 (50) | 1 (33) |
| Infection after immunosuppression | 1* (14) | 1† (50) | 0 (0) |
| Clinical outcome | |||
| Improved | 2 (29) | 0 (0) | 0 (0) |
| Worsened | 2 (29) | 0 (0) | 0 (0) |
| Death from steroid-refractory pneumonitis | 3 (43) | 2 (100) | 3 (100) |
*Herpes Zoster Shingles.
†Parainfluenza pneumonia.
CTCAE, common terminology criteria for adverse events; ICI, immune-checkpoint inhibitor; SRCIP, steroid-refractory ICI-pneumonitis.