Hi Merry.
60mg is a lot!! How long were you on Prednizone and how did you taper down? I will be 8.5 weeks (10mg the last 2 weeks) and then totally stop and hope nothing comes back. I only had 3 sessions of SBRT, but they would have been stronger than if spread out.
My Pulmonologist had mentioned immunotherapy because I have lots of nodules. Now that Prednisone helped me, he calls it radiation-induced pneumonitis, and said I would not be able to do immunotherapy because of the radiation (not the Prednisone). I don't understand enough to know if that is only for now or permanent.
I found the below article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499987/
Radiation recall pneumonitis induced by PD-1/PD-L1 blockades: mechanisms and therapeutic implications
Here are the Conclusions:
In conclusion, RRP induced by PD-1 blockade is the unique pattern of radiation-related toxicity. The clinical presentation was different from common RP and RRP induced by cytotoxic drugs. The immune checkpoint inhibitors may have evoked an inflammatory reaction in patients’ previously irradiated fields, with potential involvement of infiltrating lymphocytes and related cytokines. All RRP patients showed durable response to anti-PD-1/PD-L1. It was manageable, and sufficient steroids or corticosteroids are needed. A further analysis of the predictive factors is needed with the wide use of immune checkpoint inhibitors and high mortality of this kind of lung toxicity with combination treatment.
DEFINIITON
Radiation recall pneumonitis (RRP) is a rare but severe condition which has been mainly detected in the previously irradiated lung of patients with cancer after administering inciting agents, most commonly antineoplastic regimens including chemotherapy, targeted therapy, or immunotherapy.