Table 3.

Treatment for pneumonitis and follow-up course

PtTreatment for pneumonitisaAdmission for pneumonitisOutcome of pneumonitis treatmentReinitiation of nivolumab therapyRecurrent pneumonitisDetails of follow-up and retreatment
1Oral prednisone taper starting with 120 mg dailyNoClinical and radiographic improvementYesNoRestarted nivolumab; no recurrent pneumonitis for 46 months
2i.v. methylprednisolone taper 240 mg daily, i.v. infliximab (5 mg/kg), ICU admissionYesReferred for hospice care and diedNoNoReferred for hospice care and died
3i.v. methylprednisolone taper 150 mg daily, i.v. infliximab (5 mg/kg), ICU admission, intubationYesClinical and radiographic improvementNoNoFollow-up without therapy; no recurrent pneumonitis for 26 months
4NonebNoRadiographic improvementYesNoRestarted maintenance nivolumab monotherapy (3 mg/kg q2w); no recurrent pneumonitis for 22 months
5NoneNoClinical and radiographic improvementNoNoStarted on next systemic therapy
6Oral prednisone 120 mg dailyNoClinical and radiographic improvementNoNoStarted on next systemic therapy
7Oral prednisone taper starting at 80 mgNoClinical and radiographic improvementYesYesRestarted nivolumab (3 mg/kg q2w) and developed recurrent pneumonitis after receiving 4 doses of nivolumabc
8Oral prednisone taper starting at 100 mgNoRadiographic improvementNoNoFollow-up without therapy; no recurrent pneumonitis for 3 months
9Oral steroid taper at outside institutiondYesClinical and radiographic improvementNoNoFollow-up without therapy; no recurrent pneumonitis for 7 months
10NoneNoRadiographic improvementNoNoStarted on next systemic therapy
11i.v. methylprednisolone 120 mg, then oral prednisone taper starting at 60 mg, and i.v. infliximab (5 mg/kg)YesClinical and radiographic improvementNoNoReferred for palliative care
12Oral prednisone taper starting at 60 mg dailyYesNo imaging before next therapyNoNoStarted on next systemic therapy
13i.v. methylprednisolone 250 mg, then oral dexamethasone 12 mg daily and prednisone taper starting at 60 mg dailyYesClinical and radiographic improvementNoNoReferred for palliative care
14i.v. methylprednisolone 140 mg daily, then oral prednisone taper starting at 140 mg dailyYesClinical and radiographic improvementNoNoStarted on next systemic therapy
15Oral prednisone taper starting at 60 mg dailyNoClinical and radiographic improvementYesNoRestarted nivolumab monotherapy; no recurrent pneumonitis for 5 months
16Oral prednisone taper starting at 100 mg dailyNoClinical and radiographic improvementYesYesRestarted nivolumab and ipilimumab and received 2 doses of nivolumab and ipilimumab, and 2 doses of nivolmab; developed recurrent pneumonitise
17Oral prednisone taper starting at 70 mg dailyNoClinical and radiographic improvementNoNoFollow-up without therapy without recurrent pneumonitis for 8 months
18Oral prednisone taper starting at 40 mg dailyNoClinical and radiographic improvementNoNoStarted on next systemic therapy
19Oral prednisone taper starting at 60 mg dailyNoRadiographic improvementYesNoRestarted nivolumab and lirilumab; no recurrent pneumonitis for 2 months
20Oral prednisone taper starting at 80 mg dailyNoClinical and radiographic improvementYesNoRestarted nivolumab and lirilumab; no recurrent pneumonitis for 3 months
  • aNivolumab therapy was held at the time of pneumonitis in all patients.

  • bThe patient has been on hydrocortisone 15 mg/day for adrenal insufficiency.

  • cNivolumab was held, and the patient was treated again with prednisone taper and improved; followed without rechallenge or therapy for 4 months.

  • dNo further treatment details are available for this patient treated at the outside institution.

  • eNivolumab was held, and the patient was again treated with prednisone taper starting at 100 mg, with subsequent improvement; however, the patient experienced two episodes of pneumonitis flare, where a similar pattern of pneumonitis recurred after the completion of corticosteroid taper without retreatment of nivolumab or other systemic therapy (see Fig. 3).

    Abbreviations: Pt, patient; q, every; w, weeks.