Immune Checkpoint Inhibitor-Associated Pneumonitis in Patients Treated for Metastatic Renal Cell Carcinoma.
5 affiliations
- 1Division of Hematology/Oncology, Department of Internal Medicine, University of Virginia, Charlottesville, VA 22903, USA.
- 2Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA 22903, USA.
- 3Department of Internal Medicine, University of Virginia, Charlottesville, VA 22903, USA.
- 4Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA.
- 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Virginia, Charlottesville, VA 22903, USA.
Abstract
Immune checkpoint inhibitors (ICIs) improve outcomes in metastatic renal cell carcinoma (mRCC) but may be associated with pneumonitis. We retrospectively studied adults with mRCC who began first- or second-line ICI therapy at the University of Virginia Medical Center between 2015 and 2023. Potential cases underwent multidisciplinary clinical review, and two thoracic radiologists independently reviewed available computed tomography scans. Among 146 ICI-treated patients, 13 developed pneumonitis (8.9%; 95% CI 4.8-14.7%). Incidence did not differ significantly by treatment line or ICI regimen. Incidence was higher with prior chest radiation than without (31.8% vs. 4.8%; unadjusted odds ratio 9.2, 95% CI 2.7-31.0; Benjamini-Hochberg-adjusted p = 0.005). Five cases (38%) were grade 3-4 at diagnosis, and seven (54%) reached grade ≥ 3. Nine patients (69%) received high-dose systemic corticosteroids. Eleven patients (85%) improved or resolved with initial management; two, both with grade 1-2 pneumonitis at diagnosis, worsened and died (grade 5). Five patients underwent ICI rechallenge after clinical recovery, without recurrent pneumonitis. In this exploratory cohort, pneumonitis was sometimes fatal despite a low grade at presentation. The association with prior chest radiation is hypothesis-generating and warrants evaluation in larger studies with detailed radiation and confounder data.
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BibTeX
@article{masur2026immune,
title = {{Immune Checkpoint Inhibitor-Associated Pneumonitis in Patients Treated for Metastatic Renal Cell Carcinoma.}},
author = {Jack Masur and Abhishek Mullapudi and Soham Ali and Kathryn Fortune and Juliana Bueno and Thomas Battey and Ariaz Goudarzi and Hitesh Patel and Jeffrey Sturek and Michael Devitt and William Paul Skelton and Robert Dreicer and Paul Viscuse},
journal = {Current oncology (Toronto, Ont.)},
year = {2026},
month = oct,
doi = {10.3390/curroncol33100616},
url = {https://europepmc.org/article/MED/42930183},
note = {CC BY},
}
RIS
TY - JOUR
TI - Immune Checkpoint Inhibitor-Associated Pneumonitis in Patients Treated for Metastatic Renal Cell Carcinoma.
AU - Jack Masur
AU - Abhishek Mullapudi
AU - Soham Ali
AU - Kathryn Fortune
AU - Juliana Bueno
AU - Thomas Battey
AU - Ariaz Goudarzi
AU - Hitesh Patel
AU - Jeffrey Sturek
AU - Michael Devitt
AU - William Paul Skelton
AU - Robert Dreicer
AU - Paul Viscuse
PY - 2026
DA - 2026/10/14
JO - Current oncology (Toronto, Ont.)
DO - 10.3390/curroncol33100616
UR - https://europepmc.org/article/MED/42930183
AB - Immune checkpoint inhibitors (ICIs) improve outcomes in metastatic renal cell carcinoma (mRCC) but may be associated with pneumonitis. We retrospectively studied adults with mRCC who began first- or second-line ICI therapy at the University of Virginia Medical Center between 2015 and 2023. Potential cases underwent multidisciplinary clinical review, and two thoracic radiologists independently reviewed available computed tomography scans. Among 146 ICI-treated patients, 13 developed pneumonitis (8.9%; 95% CI 4.8-14.7%). Incidence did not differ significantly by treatment line or ICI regimen. Incidence was higher with prior chest radiation than without (31.8% vs. 4.8%; unadjusted odds ratio 9.2, 95% CI 2.7-31.0; Benjamini-Hochberg-adjusted p = 0.005). Five cases (38%) were grade 3-4 at diagnosis, and seven (54%) reached grade ≥ 3. Nine patients (69%) received high-dose systemic corticosteroids. Eleven patients (85%) improved or resolved with initial management; two, both with grade 1-2 pneumonitis at diagnosis, worsened and died (grade 5). Five patients underwent ICI rechallenge after clinical recovery, without recurrent pneumonitis. In this exploratory cohort, pneumonitis was sometimes fatal despite a low grade at presentation. The association with prior chest radiation is hypothesis-generating and warrants evaluation in larger studies with detailed radiation and confounder data.
SN - 1198-0052
SN - 1718-7729
ER -