基于程序性细胞死亡-1（PD-1）和程序性细胞死亡配体1（PD-L1）的免疫检查点抑制剂（ICI）治疗，改变了晚期非小细胞肺癌（NSCLC）的治疗范式并提高了患者的生存期望。然而，这也会导致免疫相关不良事件（iRAEs），从而造成多器官损伤。其中，在接受ICI治疗的NSCLC患者中，最常见且最具致死性的是检查点抑制剂肺炎（CIP）。CIP的呼吸道症状与原发性肺癌高度重合，这导致了其检测、诊断、管理和治疗上的困难。在临床管理中，严重CIP患者应接受免疫抑制治疗，甚至停止免疫疗法，这会影响ICI的临床益处，有可能导致肿瘤再现。因此，准确的诊断，详细解剖CIP的发病机制，以及制定合理的治疗策略对于延长患者的生存期和扩大ICI的应用是必不可少的。在此，我们首先总结了NSCLC中CIP的诊断策略，包括经典的放射学检查和不断崛起的血清学测试、病理学测试和人工智能辅助。然后，我们剖析了CIP的潜在病理机制，包括T细胞亚群紊乱、自身抗体增加、交叉抗原反应和其他免疫细胞的潜在作用等。此外，我们还探讨了除了一线类固醇治疗之外的治疗方法和基于靶向信号通路的未来方向。最后，我们讨论了目前的障碍、未来的趋势和在对抗ICI相关性肺炎方面面临的挑战。版权所有©2023 Guo、Chen、Wang和Liu。

Immune checkpoint inhibitors (ICI) therapy based on programmed cell death-1 (PD-1) and programmed cell death ligand 1 (PD-L1) has changed the treatment paradigm of advanced non-small cell lung cancer (NSCLC) and improved the survival expectancy of patients. However, it also leads to immune-related adverse events (iRAEs), which result in multiple organ damage. Among them, the most common one with the highest mortality in NSCLC patients treated with ICI is checkpoint inhibitor pneumonitis (CIP). The respiratory signs of CIP are highly coincident and overlap with those in primary lung cancer, which causes difficulties in detecting, diagnosing, managing, and treating. In clinical management, patients with serious CIP should receive immunosuppressive treatment and even discontinue immunotherapy, which impairs the clinical benefits of ICIs and potentially results in tumor recrudesce. Therefore, accurate diagnosis, detailedly dissecting the pathogenesis, and developing reasonable treatment strategies for CIP are essential to prolong patient survival and expand the application of ICI. Herein, we first summarized the diagnosis strategies of CIP in NSCLC, including the classical radiology examination and the rising serological test, pathology test, and artificial intelligence aids. Then, we dissected the potential pathogenic mechanisms of CIP, including disordered T cell subsets, the increase of autoantibodies, cross-antigens reactivity, and the potential role of other immune cells. Moreover, we explored therapeutic approaches beyond first-line steroid therapy and future direction based on targeted signaling pathways. Finally, we discussed the current impediments, future trends, and challenges in fighting ICI-related pneumonitis.Copyright © 2023 Guo, Chen, Wang and Liu.