Risk of pneumonitis with different immune checkpoint inhibitors in NSCLC

Having auspicious value in treating lung cancer, immune checkpoint inhibitors gained approval in the first-line therapy of advanced NSCLC as well as in many other solid tumors. In the last decade, immunotherapy is considered the second breakthrough after tyrosine kinase inhibitors in the management of lung cancer. Targeting immune checkpoint could put T-cell into action and enhance immune response against tumor cells. Those unleashed immune responses were expected to have collateral damage in the form of inducing plethora of autoimmune manifestations that virtually can affect any part of the body. Immune-related adverse events (IRAEs) have a distinctive pattern of development. Commonly involved sites include lung, gastrointestinal (GI) tract, skin, and endocrine glands. It seems that every immune checkpoint inhibitors have different toxicity profile. For instance, ipilimumab, an anti-CTLA-4, is associated with early development of mucocutaneous complications followed by GI affection. On the other hand, nivolumab, an anti-PD-1, has a relatively delayed onset of its AEs.