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- W2912055136 abstract "Les immunothérapies anti-PD1 sont devenues un traitement incontournable dans les cancers bronchiques. Cependant, certaines toxicités, dont les atteintes pulmonaires interstitielles, peuvent être sévères. À ce titre, les patients porteurs de pneumopathies interstitielles diffuses (PID) ont été exclus des essais cliniques et peu de données sont disponibles dans cette population. Le cancer bronchique constitue pourtant une complication majeure des PID, en particulier de la fibrose pulmonaire idiopathique (FPI). Nous rapportons 3 cas de FPI traités par nivolumab. Tous avaient une FPI avec un retentissement respiratoire modéré. Les patients avaient tous reçu au moins une ligne de chimiothérapie. Deux patients ont présenté une progression tumorale rapide sans toxicité immunologique. Le troisième a présenté une réponse partielle mais une colite de grade 3 qui a fait stopper le traitement. Aucun n’a présenté de toxicité pulmonaire ni d’aggravation clinique ou radiologique de la FPI. L’inflammation et l’auto-immunité sont des mécanismes probablement marginaux dans la FPI. Dans ce contexte, la balance bénéfice/risque doit être discutée au cas par cas, pour des patients ayant une FPI non sévère et aucun signe d’auto-immunité. Du fait de l’épidémiologie et du rôle croissant de l’immunothérapie dans le cancer bronchique, des cohortes prospectives paraissent nécessaires pour cette population. Anti-PD1 immunotherapies have become an essential treatment for bronchial cancer. According to published studies, PD1 and PD-L1 inhibitors have a better toxicity profile than chemotherapy. Nevertheless, some immune related toxicities can be potentially severe, such as induced interstitial lung disease (ILD). Currently, ILD patients are excluded from clinical trials using immunotherapy in lung cancer. IPF is the most frequent and severe form of ILD. Lung cancer represents a major complication of this disease and to date few data exist on the safety of immunotherapy in this context. We report 3 cases of IPF with lung cancer treated by nivolumab. All had a clinically mild to moderate IPF. The patients had received at least one line of chemotherapy before nivolumab and had progressive, metastatic lung cancer. Two patients experienced rapid cancer progression without immune toxicities. The third had a partial response but developed grade III immune colitis that led to discontinuation of the treatment. None developed lung toxicity or worsening of IPF on CT during follow-up, and death was always related to progression of the cancer. In our series of three patients with IPF, nivolumab was well tolerated with regard to their pulmonary condition. As inflammation and autoimmunity are probably marginal mechanisms in the pathogenesis of IPF, we do not believe that the presence of IPF should definitely disqualify potential candidates for treatment with nivolumab. Decisions should be taken, case-by-case, in selected patients without severe IPF and with no evidence of autoimmunity. In view of the epidemiology of lung cancer in IPF and the critical role of immunotherapy in the management of lung cancer, studies of prospective cohorts are urgently needed in this population." @default.
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- W2912055136 date "2019-02-01" @default.
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- W2912055136 title "Le nivolumab peut-il être utilisé dans les fibroses pulmonaires idiopathiques ?" @default.
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- W2912055136 doi "https://doi.org/10.1016/j.rmr.2018.11.001" @default.
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