AUTHOR=Dumoulin Daphne W. , Gietema Hester A. , Paats Marthe S. , Hendriks Lizza E. L. , Cornelissen Robin 

TITLE=Differentiation of COVID-19 Pneumonitis and ICI Induced Pneumonitis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 10 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.577696

DOI=10.3389/fonc.2020.577696

ISSN=2234-943X

ABSTRACT=Immune checkpoint inhibitors (ICI) have become standard of care treatment for several tumor types and stages. An important complication of ICI is ICI-induced pneumonitis. Cancer has been reported to be one of the risk factors for serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, that has engulfed the world in the last couple of months.  In cancer patients treated with ICI presenting at the emergency department during the COVID-19 pandemic, correct diagnosis can be challenging.  Symptoms and radiological features of ICI pneumonitis can be overlapping with those of COVID-19 pneumonia. For the latter, no proven therapy exists, although multiple therapies are under investigation. In contrast, ICI pneumonitis must be treated in most cases with immunosuppressive therapy, as this is a potentially fatal adverse event. It has been suggested that immunosuppression increases the risk of complicated COVID-19. Therefore, distinction between these two entities is warranted.  This paper will summarize the clinical, radiological features as well as additional investigations of both entities, leading to a suggested diagnostic algorithm. This algorithm may be a supportive tool for clinicians to diagnose the underlying cause of the pneumonitis in patients treated with ICI during this COVID-pandemic.