Cyclosporine successful treated Steroid-resistant checkpoint inhibitor-related pneumonitis: A case report

Abstract

Abstract Background Immune checkpoint inhibitor-related pneumonitis (CIP) stands out as a particularly severe adverse event caused by cancer immunotherapy, with a substantial real-world incidence ranging from 13–19%. While systemic corticosteroids represent the standard treatment for CIP, therapeutic options become limited in cases where patients do not respond to steroid therapy. Such patients are classified as having steroid-resistant CIP, often associated with a poor prognosis. This case study provides insight into the symptoms, diagnostic process, and treatment approach for steroid-resistant CIP. Notably, successful management is demonstrated through the utilization of cyclosporine, highlighting its potential mechanisms of action in effectively treating steroid-resistant CIP. Case description: Here, we present the case of a 53-year-old male patient diagnosed with stage IVA non-small cell lung cancer(NSCLC), who experienced elevated fever, cough, and difficulty in breathing subsequent to immunotherapy treatment. Based on his medical history, clinical presentation, and imaging results, the patient was confirmed to have CIP. The patient's condition demonstrated improvement upon administration of corticosteroids; however, during the subsequent tapering of corticosteroid treatment, a resurgence of CIP occurred, eventually leading to a state of respiratory failure. Consequently, we arrived at the diagnosis of steroid-resistant CIP, prompting the implementation of a combination therapy involving cyclosporine in conjunction with corticosteroids to establish stable disease control. As the corticosteroid dosage was systematically reduced, the patient continued to exhibit a favorable response with no observable recurrence. Conclusions This marks the inaugural instance of effectively managing steroid-resistant CIP through the synergistic employment of cyclosporine and corticosteroids. Presently, cases of steroid-resistant CIP remain infrequent, necessitating vigilant and meticulous monitoring within clinical settings. Notably, there exists no distinct guideline specifying a singular agent for rescuing patients insensitive to corticosteroid therapy. Thus, cyclosporine emerges as a promising and efficacious treatment alternative for individuals unresponsive to corticosteroid intervention in the context of CIP.