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Volume 14
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10.3390/jcm14176133
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Lung Toxicity from Immune Checkpoint Inhibitors: A Diagnostic Approach

by
Ana Casal
1,2,*,
Virginia Leiro-Fernandez
1,2,3,
Laura Villar-Aguilar
1,2,
Manuel Casal-Guisande
2,3,4,
Mar Mosteiro-Añón
1,2,
Maribel Botana-Rial
1,2,3,
Cristina Represas-Represas
1,2,3,
María Torres-Durán
1,2,3 and
Alberto Fernández-Villar
1,2,3,5
1
Pulmonary Department, Hospital Universitario Álvaro Cunqueiro, 36312 Vigo, Spain
2
NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
3
Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
4
Fundación Pública Galega de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
5
School of Industrial Engineering, University of Vigo, 36310 Vigo, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(17), 6133; https://doi.org/10.3390/jcm14176133
Submission received: 13 August 2025 / Revised: 25 August 2025 / Accepted: 27 August 2025 / Published: 29 August 2025
(This article belongs to the Topic The Tumor Microenvironment, Immuno-Oncology, and Immune Checkpoint: Implications for Current and Emergent Immunotherapies, 2nd Edition)
Versions Notes

Abstract

The use of immune checkpoint inhibitors (ICIs) has increased exponentially in recent years, leading to a significant impact on cancer patient survival. However, their administration can trigger immune-mediated adverse effects, notably pulmonary toxicity, which is a potentially serious complication. ICI-induced pneumonitis has a variable incidence ranging from 5 to 19% and usually appears in the first few months of treatment. The diagnosis requires a high index of suspicion, especially in patients with risk factors (elderly male smokers with squamous cell lung cancer, previous respiratory or autoimmune disease, and receiving combination treatment with other ICIs or chemo-radiotherapy). Chest computed tomography (CT) is a key test, allowing the identification of different radiological patterns. This study can be completed with bronchoscopy with bronchoalveolar lavage (BAL) to rule out infection or tumour progression. In general terms, treatment is based on discontinuing the causative drug, with or without the initiation of systemic corticosteroids, escalating to immunosuppressants depending on the severity and/or refractoriness of the condition. This paper provides an updated narrative review of ICI pulmonary toxicity, addressing its pathophysiology, different types of lung damage, diagnostic and therapeutic algorithms, and the emerging role of biomarkers such as KL-6 or IL-6. This article emphasises the need for a multidisciplinary approach and further prospective studies to optimise the management and prognosis of this immune-mediated complication.
Keywords: immune checkpoint inhibitors; lung damage; pneumonitis immune checkpoint inhibitors; lung damage; pneumonitis

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MDPI and ACS Style

Casal, A.; Leiro-Fernandez, V.; Villar-Aguilar, L.; Casal-Guisande, M.; Mosteiro-Añón, M.; Botana-Rial, M.; Represas-Represas, C.; Torres-Durán, M.; Fernández-Villar, A. Lung Toxicity from Immune Checkpoint Inhibitors: A Diagnostic Approach. J. Clin. Med. 2025, 14, 6133. https://doi.org/10.3390/jcm14176133

AMA Style

Casal A, Leiro-Fernandez V, Villar-Aguilar L, Casal-Guisande M, Mosteiro-Añón M, Botana-Rial M, Represas-Represas C, Torres-Durán M, Fernández-Villar A. Lung Toxicity from Immune Checkpoint Inhibitors: A Diagnostic Approach. Journal of Clinical Medicine. 2025; 14(17):6133. https://doi.org/10.3390/jcm14176133

Chicago/Turabian Style

Casal, Ana, Virginia Leiro-Fernandez, Laura Villar-Aguilar, Manuel Casal-Guisande, Mar Mosteiro-Añón, Maribel Botana-Rial, Cristina Represas-Represas, María Torres-Durán, and Alberto Fernández-Villar. 2025. "Lung Toxicity from Immune Checkpoint Inhibitors: A Diagnostic Approach" Journal of Clinical Medicine 14, no. 17: 6133. https://doi.org/10.3390/jcm14176133

APA Style

Casal, A., Leiro-Fernandez, V., Villar-Aguilar, L., Casal-Guisande, M., Mosteiro-Añón, M., Botana-Rial, M., Represas-Represas, C., Torres-Durán, M., & Fernández-Villar, A. (2025). Lung Toxicity from Immune Checkpoint Inhibitors: A Diagnostic Approach. Journal of Clinical Medicine, 14(17), 6133. https://doi.org/10.3390/jcm14176133

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