Nintedanib in an elderly nonsmall-cell lung cancer patient with severe steroid-refractory checkpoint inhibitor-related pneumonitis - A case report and literature review

Sep 24, 2026

Uploaded by dhado

Immune checkpoint inhibitors improve cancer outcomes but can trigger severe immune-related adverse events, and checkpoint inhibitor-related pneumonitis (CIP) remains a clinically challenging cause of premature death. Current CIP guidance emphasizes immunosuppressive therapy, while anti-fibrotic treatment is needed especially for patients with poor corticosteroid response and prolonged disease. This review presents a case supporting nintedanib as a promising option for CIP management or prevention due to anti-fibrotic efficacy and an acceptable safety profile, with potential to limit tumor progression and benefit from combination anti-tumor strategies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Introduction

Background and rationale for CIP management

Incidence and severity of checkpoint inhibitor-related pneumonitis

Role and limitations of corticosteroids

TYPE Review PUBLISHED 10 January 2023 DOI 10.3389/fimmu.2022.1072612 OPEN ACCESS EDITED BY Kevin Sheng-Kai Ma, University of Pennsylvania, United States REVIEWED BY Xinan Wang, Harvard University, United States Enchao Qiu, Thomas Jefferson University, United States *CORRESPONDENCE Delei Kong [kongdelei@126.com](kongdelei@126.com) †These authors have contributed equally to this work and share ﬁrst authorship SPECIALTY SECTION This article was submitted to Cancer Immunity and Immunotherapy, a section of the journal Frontiers in Immunology RECEIVED 17 October 2022 ACCEPTED 19 December 2022 PUBLISHED 10 January 2023 CITATION Pan L, Meng F, Wang W, Wang X-h, Shen H, Bao P, Kang J and Kong D (2023) Nintedanib in an elderly nonsmall-cell lung cancer patient with severe steroid-refractory checkpoint inhibitor-related pneumonitis: A case report and literature review. Front. Immunol. 13:1072612 . doi: 10.3389/fimmu.2022.1072612 COPYRIGHT © 2023 Pan, Meng, Wang, Wang, Shen, Bao, Kang and Kong. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Nintedanib in an elderly nonsmall-cell lung cancer patient with severe steroid-refractory checkpoint inhibitor-related pneumonitis: A case report and literature review Lei Pan 1†, Fanqi Meng 1,2†, Wei Wang1, Xu-hao Wang 1,2, Hui Shen 1, Pengchen Bao 2, Jian Kang 1 and Delei Kong 1* 1 Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China, 2The First Clinical College, China Medical University, Shenyang, China Immune checkpoint inhibitors tremendously improve cancer prognosis; however, severe-grade immune-related adverse events may cause premature death. Current recommendations for checkpoint inhibitor-related pneumonitis(CIP)treatment are mainly about immunosuppressive therapy, and anti-ﬁbrotic agents are also needed, especially for patients with poor response to corticosteroids and a longer pneumonitis course. This is because ﬁbrotic changes play an important role in the pathological evolution ofCIP. Here, wereporta case demonstrating that nintedanibis a promising candidate drug for CIP management or prevention, as it has potent anti-ﬁbrotic efﬁcacyanda safety proﬁle. Moreover, nintedanib could partially inhibit tumor growth in patients with non-small-cell lung cancer, and its efﬁcacy can be improved in combination with other anti-tumor therapies. KEYWORDS checkpoint inhibitor-related pneumonitis, nintedanib, pulmonary ﬁbrosis, non-smallcell lung cancer, immunotherapy Highlights: · Steroid-refractory CIP in patients with non-small-cell lung cancer (NSCLC) maybe particularly lethal owing to progressive respiratory failure and compromised immune system during immunosuppressive treatment of CIP. · Nintedanib showed great efﬁcacy with good tolerance in treating sustained interstitial ﬁbrosis and reducing pulmonary function decline in the long course of CIP. Frontiers in Immunology 01 [frontiersin.org](frontiersin.org) · Nintedanib is an anti-tumor-supporting agent inpatients with NSCLC, which can positively control tumor growth in combination with chemotherapy and might boost immunotherapy and prevent CIP when used with immune checkpoint inhibitors. 1 Introduction Immune checkpoint inhibitors (ICIs), including programmed cell death 1 (PD-1) or its ligand programmed cell death ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitors, have made major breakthroughs in improving the progression-free survival (PFS) and overall survival (OS) rates of lung cancer p

FAQs

Why is checkpoint inhibitor-related pneumonitis a major concern in lung cancer immunotherapy?

Because CIP can range from mild to life-threatening severity and often requires immunomodulatory treatment. It is associated with substantial fatality rates and premature death risk during immunosuppressive therapy.

What are the current main recommendations for treating CIP?

Guidelines focus on immunosuppressive therapy, with corticosteroids as the core treatment for any grade. Additional immunosuppressive agents may be needed for steroid-refractory cases, especially in severe grades.

How does the article position nintedanib in CIP management?

The case report and literature review suggest nintedanib as a promising candidate for CIP management or prevention, citing potent anti-fibrotic efficacy, a tolerable safety profile, and possible benefits for tumor growth control when combined with other anti-tumor therapies.

Sep 24, 2026

Uploaded by dhado