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Background/Aim <p>Immune checkpoint inhibitor–related pneumonitis (IIP) is one of the most serious immune-related adverse events and remains a major challenge in clinical practice. This study aimed to describe the clinical, radiologic, and laboratory characteristics of patients who developed IIP and to explore factors associated with pneumonitis severity in a real-world cohort.</p> Methods <p>This retrospective single-center study evaluated adult patients treated with immune checkpoint inhibitors between January 2019 and September 2024. Patients who developed IIP were analyzed. The primary endpoint was pneumonitis severity, categorized as mild (Grade 1–2) or severe (Grade 3–4) according to CTCAE v5.0. Demographic characteristics, cancer types, prior treatments, laboratory findings, thoracic CT patterns, corticosteroid use, treatment decisions, and clinical outcomes were assessed, and radiologic and laboratory markers were compared between severity groups.</p> Results <p>The incidence of IIP was 9.1%. The mean age of affected patients was 64.9 ± 9.8 years, and 73.3% were male. Lung cancer was the most common underlying malignancy (56.7%). Consolidation was the predominant radiologic pattern (36.7%), followed by bilateral diffuse involvement (26.7%). Severe pneumonitis occurred in 53.3% of patients. Lymphocyte count (<i>p</i> = 0.015) and lymphocyte percentage (<i>p</i> = 0.002) were significantly higher in Grade 1–2 cases, whereas LDH and D-dimer levels tended to be higher in Grade 3–4 disease. Severe pneumonitis was associated with greater use of systemic corticosteroids (100% vs. 66.7%, <i>p</i> = 0.018) and permanent discontinuation of immunotherapy (100% vs. 33.3%, <i>p</i> &lt; 0.001). Overall mortality was 60%, and pneumonitis-related mortality was 26.7%.</p> Conclusion <p>IIP is a heterogeneous but potentially life-threatening complication of immunotherapy, with a higher incidence in real-world practice, particularly among patients with lung cancer. Readily available laboratory markers and radiologic patterns may assist in early severity stratification; however, larger prospective studies are required to validate these findings.</p>

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Determinants of severity in immune checkpoint inhibitor–related pneumonitis: clinical, radiologic, and laboratory insights from real-life clinical data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月28日

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  • Esma Sevil Akkurt,
  • Ozlem Duvenci Birben,
  • Ilknur Deliktas Onur,
  • Duygu Dagli,
  • Ozturk Ates,
  • Derya Yenibertiz

摘要

Background/Aim

Immune checkpoint inhibitor–related pneumonitis (IIP) is one of the most serious immune-related adverse events and remains a major challenge in clinical practice. This study aimed to describe the clinical, radiologic, and laboratory characteristics of patients who developed IIP and to explore factors associated with pneumonitis severity in a real-world cohort.

Methods

This retrospective single-center study evaluated adult patients treated with immune checkpoint inhibitors between January 2019 and September 2024. Patients who developed IIP were analyzed. The primary endpoint was pneumonitis severity, categorized as mild (Grade 1–2) or severe (Grade 3–4) according to CTCAE v5.0. Demographic characteristics, cancer types, prior treatments, laboratory findings, thoracic CT patterns, corticosteroid use, treatment decisions, and clinical outcomes were assessed, and radiologic and laboratory markers were compared between severity groups.

Results

The incidence of IIP was 9.1%. The mean age of affected patients was 64.9 ± 9.8 years, and 73.3% were male. Lung cancer was the most common underlying malignancy (56.7%). Consolidation was the predominant radiologic pattern (36.7%), followed by bilateral diffuse involvement (26.7%). Severe pneumonitis occurred in 53.3% of patients. Lymphocyte count (p = 0.015) and lymphocyte percentage (p = 0.002) were significantly higher in Grade 1–2 cases, whereas LDH and D-dimer levels tended to be higher in Grade 3–4 disease. Severe pneumonitis was associated with greater use of systemic corticosteroids (100% vs. 66.7%, p = 0.018) and permanent discontinuation of immunotherapy (100% vs. 33.3%, p < 0.001). Overall mortality was 60%, and pneumonitis-related mortality was 26.7%.

Conclusion

IIP is a heterogeneous but potentially life-threatening complication of immunotherapy, with a higher incidence in real-world practice, particularly among patients with lung cancer. Readily available laboratory markers and radiologic patterns may assist in early severity stratification; however, larger prospective studies are required to validate these findings.