Clinical evaluation and management of checkpoint inhibitor pneumonitis with advanced biliary tract cancer: a report of 3 cases

doi:10.16139/j.1007-9610.2025.06.10

Abstract

Abstract:

Objective To report cases of checkpoint inhibitor pneumonitis （CIP） in patients with advanced biliary tract cancer, aiming to provide additional approaches for the assessment, treatment, and monitoring of this condition. Methods Three patients developed oxygen desaturation and interstitial lung lesions during chemotherapy combined with immunotherapy, and were diagnosed with CIP in collaboration with the respiratory department. Antitumor therapy was discontinued in the acute phase, and glucocorticoids were administered, with regular monitoring of disease progression. During follow-up, case 1 developed lung metastasis; case 2 showed improvement; case 3 had concurrent infection and tumor progression. Results Glucocorticoids improved lung lesions and hypoxic symptoms in patients with CIP, but attention should be paid to the potential for concurrent infections and tumor progression. Conclusions Comprehensive assessment and early identification of CIP are crucial for patients with advanced biliary tract cancer. For those with recurrent symptoms after glucocorticoid therapy, timely and accurate adjustment of the treatment regimen is essential.

Key words: Advanced biliary tract cancer, Immune-related adverse events(irAE), Checkpoint inhibitor pneumonitis(CIP)

CLC Number:

R735.8

SUN Xueying, WU Bin, JIANG Yifei, LIAO Zhuojun, ZHAO Jinyan, ZHOU Ying, ZHANG Shulong, WANG Yan, LIU Houbao. Clinical evaluation and management of checkpoint inhibitor pneumonitis with advanced biliary tract cancer: a report of 3 cases[J]. Journal of Surgery Concepts & Practice, 2025, 30(06): 517-523.

Figures/Tables 5

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Item	Case 1	Case 2	Case 3
Gender/age(year)	Male/59	Female/79	Female/72
Weight (kg)/height (cm)	50/158	56/158	48/147
ECOG score	0	0	0
Onset time	2023.11	2024.09	2024.01
Medical history	Renal malignant tumor, hepatitis B virus infection	Hypertension, cerebral infarction, pneumonia, left lower extremity venous thrombosis	Common bile duct stones with ERCP history
Smoking history	Denied	Denied	Denied
Diagnosis	Poorly differentiated gallbladder adenocarcinoma, T3N1M1, ⅣB	Poorly differentiated gallbladder adenocarcinoma, T3N1M0, ⅢB	Intrahepatic cholangiocarcinoma,T4NxM1, Ⅳ
CIP grade (CTCAE v5.0)	2	2	3
The cycle of CIP Onset	11 cycles	2 cycles	13 cycles
SpO₂ (without oxygen inhalation)	90%	85%-90%	90%

Grades	CTCAE v5.0
Grade 1	Mild: asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated.
Grade 2	Moderate: minimal, local or noninvasive intervention indicated; limiting age appropriate instrumental activities of daily living (ADL), such as clothes, using the telephone, managing money.
Grade 3	Severe or medically significant but not immediately life-threatening: hospitalization or prolongation of hospitalization indicated; disabling; limiting self care ADL, such as bathing, dressing and undressing, feeding self, using the toilet, taking medications, and not bedridden.
Grade 4	Life-threatening consequences: urgent intervention indicated.
Grade 5	Death related to adverse event.