Interstitial, Inflammatory & Occupational Lung DiseaseImmune-related Pulmonary Toxicity From Cancer Immunotherapy: A Systematic ApproachThiruchelvam, Nirosshan MD*; Rajasurya, Venkat MD†; Tharmendira, Sivagowri MD‡; Torbic, Heather PharmD, BCPS, BCCCP§; Waldron, Madeline PharmD§; Stoller, James K. MD, MS∥; Culver, Daniel A. DO*Author Information *Respiratory Institute §Department of Pharmacy ∥Education and Respiratory Institutes, Cleveland Clinic, Cleveland, OH †Department of Pulmonary and Critical Care Medicine, Novant Health, Winston Salem, NC ‡Department of Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT Disclosure: The authors declare that they have no conflicts of interest. Address correspondence to: Nirosshan Thiruchelvam, MD, 9500 Euclid Avenue, A90, Cleveland, OH 44195. E-mail: [email protected]. Clinical Pulmonary Medicine: November 2020 - Volume 27 - Issue 6 - p 183-192 doi: 10.1097/CPM.0000000000000383 Buy Metrics Abstract Immune checkpoint inhibitors (ICIs) are one of the major advances in cancer treatment. ICIs have shown significant benefit in treating several types of cancer. Currently there are 6 ICIs available in the United States and multiple ICIs in the pipeline. Immune checkpoint signaling leads to immune tolerance of cancer cells through downregulation of T-cell activation. The reversal in tumor-tolerance and self-tolerance effected by ICIs likely drives both T-cell–mediated toxicity and immune-related adverse effects (irAEs); however, the exact mechanism remains not completely understood. Pulmonary irAEs are among the most feared high-grade irAEs leading to discontinuation of ICIs and, not uncommonly, treatment-related death. Because of the high degree of morbidity and mortality associated with pulmonary irAEs and the exponential growth of ICI use, clinicians must increasingly be facile in diagnosing and managing these irAEs. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.