Thoracic Imaging of Non-Small Cell Lung Cancer Treated with Anti-Programmed-Death-Receptor-1 (PD-1) Therapy

Publication date: Available online 31 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Mark Hammer, Stephen Bagley, Charu Aggarwal, Joshua Bauml, Arun Nachiappan, Charles B. Simone, Corey Langer, Sharyn I. Katz
PurposeTreatment with anti-programmed-death-receptor-1 (PD1) therapeutics can lead to unconventional responses and side effect profiles due to their potentiating effects on the immune system. Here we evaluate the radiologic manifestations of anti-PD1 therapy in the chest in patients with non-small cell lung cancer (NSCLC) receiving anti-PD1 therapy.Materials and MethodsA retrospective review of real-world clinical practice was conducted of all the NSCLC patients receiving anti-PD1 therapy at our institution between 2013–2016. All patients without adequate clinical or radiologic follow-up data in the electronic medical records were excluded. Imaging examinations for all patients deemed by their thoracic oncologists to have radiologic pseudoprogression or therapy associated pneumonitis were reviewed by experienced thoracic radiologists.ResultsA total of 166 patients with NSCLC had available clinical and imaging data for retrospective review. Of these patients, 4 (2%) were considered to have radiologic pseudoprogression, 3 of which manifested as increased tumor size and 1 of which manifested with new lesions. A total of 5 patients (3%) were clinically deemed to have pneumonitis attributable to anti-PD1 therapy, 4 of which had radiologic manifestations on computed tomography (CT).ConclusionRadiologic pseudoprogression and drug-induced pneumonitis are uncommon but important manifestations of anti-PD1 therapy on thoracic imaging.



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