Table 3.
Proposed Reporting of Common Measures and Terminology for Immune Checkpoint Inhibitor Pneumonitis
| Research Topic in ICI-Pneumonitis | Proposed Research Reporting Components |
|---|---|
| Demographics and baseline clinical characteristics | Demographic information (sex, age, and ethnicity) |
| Smoking history (categorical and quantitative [pack-years]) | |
| Preexisting conditions (particularly interstitial lung disease, COPD, and systemic autoimmune diseases) | |
| Tumor types | |
| Prior treatments | |
| Type of ICI treatment and regimen, doses, and frequency | |
| Radiologic findings of ICI-pneumonitis | Use of common terminology |
| Routine use of radiologic patterns rather than characteristic findings (examples below) | |
| • COP pattern | |
| • AIP/ARDS pattern | |
| • NSIP pattern | |
| • HP pattern | |
| Modality: chest CT | |
| Pathologic findings of ICI-pneumonitis | Use of common terminology: |
| • Cellular interstitial pneumonia | |
| • Fibrosing interstitial pneumonia | |
| • Usual interstitial pneumonia | |
| • Nonspecific interstitial pneumonia | |
| • Cellular and fibrosing interstitial pneumonia | |
| • Organizing pneumonia | |
| • Bronchiolitis | |
| • Lymphocytic interstitial pneumonia | |
| • Diffuse alveolar damage | |
| • Pleuritis | |
| • Noncaseating granulomas | |
| Clinical findings of ICI-pneumonitis | Document both CTCAE grade and clinical signs and symptoms |
| Infectious complications | In ICI alone and in combination with corticosteroids and other immunosuppressive medications |
| • TB and listeria (PD-[L]1) | |
| • Aspergillus, CMV, and PJP (CTLA-4) | |
| • Pneumonia (organism[s] when available) | |
| • Sepsis (organism[s] when available) | |
| • Other bacterial, viral, and fungal infections | |
| Additional testing | Patient-reported functional assessments |
| • Borg scale | |
| • FACT-L questionnaire | |
| Pulmonary function testing | |
| • Spirometry and diffusing capacity (corrected for Hb) | |
| • TLC | |
| • Comparison with pretreatment measures | |
| 6-min-walk test | |
| Bronchoscopy (BAL) | |
| • Volume, location sampled (affected lobe), and protocol for processing | |
| • Cell differential, subsets, and surface markers | |
| • Measures: cytokines, chemokines, and microbiome | |
| • Treatments (pre/post steroids and pre/post antibiotics) | |
| • Correlation with disease severity and temporality | |
| Lung biopsy | |
| • Type (TBBx, cryobiopsy, or wedge) and location | |
| • Uniform histologic terminology | |
| • Presence/absence of malignancy and evidence of infection? | |
| • Complications |
Definition of abbreviations: AIP = acute interstitial pneumonia; ARDS = acute respiratory distress syndrome; CMV = Cytomegalovirus; COP = cryptogenic organizing pneumonia; COPD = chronic obstructive pulmonary disease; CT = computed tomography; CTCAE = Common Terminology Criteria for Adverse Events; CTLA = cytotoxic T-lymphocyte–associated protein; FACT-L = Functional Assessment of Cancer Therapy–Lung; HP = hypersensitivity pneumonitis; ICI = immune checkpoint inhibitor; NSIP = nonspecific interstitial pneumonia; PD-(L)1 = PD-1 (programmed cell death protein 1) and PD-L1 (programmed death ligand 1); PJP = Pneumocystis jiroveci pneumonia; TB = tuberculosis; TBBx = transbronchial biopsy.