Journal of Surgery Concepts & Practice >

2025 , Vol. 30 >Issue 06: 517 - 523

DOI: https://doi.org/10.16139/j.1007-9610.2025.06.10

Original article

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

  • SUN Xueying ,
  • WU Bin ,
  • JIANG Yifei ,
  • LIAO Zhuojun ,
  • ZHAO Jinyan ,
  • ZHOU Ying ,
  • ZHANG Shulong ,
  • WANG Yan ,
  • LIU Houbao
Expand
  • 1a. Department of General Medicine, b. Department of General Surgery, Shanghai Xuhui District Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai 200237, China
    2. Department of General Surgery, Zhongshan Hospital, Fudan University; Biliary Tract Diseases Institute, Fudan University; Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China

Received date: 2025-05-30

  Online published: 2026-01-26

Fold

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)

Cite this article

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 . DOI: 10.16139/j.1007-9610.2025.06.10

References

[1] VOGEL A, BRIDGEWATER J, EDELINE J, et al. Biliary tract cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2023, 34(2):127-140.
[2] CHEN S, HAN K, SONG Y, et al. Current status, trends, and predictions in the burden of gallbladder and biliary tract cancer in China from 1990 to 2019[J]. Chin Med J (Engl), 2022, 135(14):1697-1706.
[3] ZHOU J, TAN G, ZHANG L, et al. Epidemiology of biliary tract cancer in China: a narrative review[J]. Chin J Cancer Res, 2024, 36(5):474-488.
[4] 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专家工作组. 胆道恶性肿瘤转化治疗专家共识(2025)[J]. 中华外科杂志, 2025, 63(6):453-460.
  Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association; Working Group of Biliary Surgeons, Chinese College of Surgeons, Chinese Medical Doctor Association. Expert consensus on conversion therapy of biliary tract cancer (2025)[J]. Chin J Surg, 2025, 63(6):453-460.
[5] OH D Y, HE A R, BOUATTOUR M, et al. Durvalumab or placebo plus gemcitabine and cisplatin in participants with advanced biliary tract cancer (TOPAZ-1): updated overall survival from a randomised phase 3 study[J]. Lancet Gastroenterol Hepatol, 2024, 9(8):694-704.
[6] KELLEY R K, UENO M, YOO C, et al. Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2023, 401(10391):1853-1865.
[7] JIANG C, YANG L, KONG L Y, et al. Comparing immunotherapy versus chemotherapy alone as second-line therapy for malignant tumors of the biliary tract: a retrospective study[J]. Clin Med Insights Oncol, 2025, 19:11795549251317012.
[8] LAFACE C, FINA E, RICCI A D, et al. Immunobiology of biliary tract cancer and recent clinical findings in approved and upcoming immune checkpoint inhibitors[J]. Expert Opin Biol Ther, 2024, 24(12):1363-1374.
[9] PENG Z, DONG J, TANG S, et al. Efficacy and safety of immune checkpoint inhibitors in patients with advanced intrahepatic cholangiocarcinoma[J]. Front Oncol, 2025, 15:1498887.
[10] FREY C, ETMINAN M. Adverse events of PD-1, PD-L1, CTLA-4, and LAG-3 immune checkpoint inhibitors: an analysis of the FDA adverse events database[J]. Antibo-dies (Basel), 2024, 13(3):59.
[11] XU Y, CHEN R, PAN R, et al. Clinical management of checkpoint inhibitor pneumonitis: focus, challenges, and future directions[J]. Chin Med J Pulm Crit Care Med, 2025, 3(1):29-40.
[12] RASCHI E, ROSSI S, DE GIGLIO A, et al. Cardiovascular toxicity of immune checkpoint inhibitors: a guide for clinicians[J]. Drug Saf, 2023, 46(9):819-833.
[13] SIMBAQUEBA CLAVIJO C, ODARO O, GANDHI A, et al. Immunotherapy-related adverse events and clinical outcomes in adult solid-tumor patients admitted to an onco-hospitalist medicine service[J]. Cancers (Basel), 2025, 17(3):403.
[14] 中华医学会呼吸病学分会, 中国抗癌协会肿瘤呼吸病专业委员会, 北京肿瘤防治研究会. 免疫检查点抑制剂相关肺炎诊治和管理专家共识(2025)[J]. 中华结核和呼吸杂志, 2025, 48(4):329-343.
  Chinese Thoracic Society, Chinese Medical Association; Oncology Respiratory Disease Committee of China Anti-Cancer Association; Beijing Cancer Prevention and Treatment Research Association. Chinese experts consensus on the diagnosis and management of checkpoint inhibitor pneumonitis(2025)[J]. Chin J Tuberc Respir Dis, 2025, 48(4):329-343.
[15] LIN M X, ZANG D, LIU C G, et al. Immune checkpoint inhibitor-related pneumonitis: research advances in prediction and management[J]. Front Immunol, 2024, 15:1266850.
[16] WANG X, BAI Y, CHAI N, et al. Chinese national clinical practice guideline on diagnosis and treatment of biliary tract cancers[J]. Chin Med J (Engl), 2024, 137(19):2272-2293.
[17] CHEEMA P K, IAFOLLA M A J, ABDEL-QADIR H, et al. Managing select immune-related adverse events in patients treated with immune checkpoint inhibitors[J]. Curr Oncol, 2024, 31(10):6356-6383.
[18] HAANEN J, OBEID M, SPAIN L, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2022, 33(12):1217-1238.
[19] KARAYAMA M, INUI N, INOUE Y, et al. Risk factors for relapse of immune-related pneumonitis after 6-week oral prednisolone therapy: a follow-up analysis of a phase Ⅱ study[J]. BMC Pulm Med, 2024, 24(1):495.
[20] SILVERSTEIN J, WRIGHT F, WANG M, et al. Evaluating survival after hospitalization due to immune-related adverse events from checkpoint inhibitors[J]. Oncologist, 2023, 28(10):e950-e959.
[21] VALENTE M, COLUCCI M, VEGNI V, et al. A multidisciplinary approach to improve the management of immune-checkpoint inhibitor-related pneumonitis[J]. Onco Targets Ther, 2024, 17:673-681.
[22] DAETWYLER E, WALLRABENSTEIN T, KONIG D, et al. Corticosteroid-resistant immune-related adverse events: a systematic review[J]. J Immunother Cancer, 2024, 12(1):e007409.
[23] VOGEL A, DUCREUX M, ESMO Guidelines Committee. ESMO clinical practice guideline interim update on the management of biliary tract cancer[J]. ESMO Open, 2025, 10(1):104003.
[24] ZHAO Y, YANG M, FENG J, et al. Advances in immunotherapy for biliary tract cancers[J]. Chin Med J (Engl), 2024, 137(5):524-532.
[25] THOMPSON J A, SCHNEIDER B J, BRAHMER J, et al. NCCN guidelines(R) insights: management of immunotherapy-related toxicities, version 2.2024[J]. J Natl Compr Canc Netw, 2024, 22(9):582-592.
[26] THOMPSON J A, SCHNEIDER B J, BRAHMER J, et al. Management of immunotherapy-related toxicities, version 1.2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2022, 20(4):387-405.
[27] BADEN L R, SWAMINATHAN S, ALMYROUDIS N G, et al. Prevention and treatment of cancer-related infections, version 3.2024, NCCN Clinical Practice Guidelines in oncology[J]. J Natl Compr Canc Netw, 2024, 22(9):617-644.
Options
Outlines

/

〈 〉