Jun Fukihara1, Koji Sakamoto2, Junji Koyama3, Takayasu Ito4, Shingo Iwano5, Masahiro Morise1, Masahiro Ogawa6, Yasuhiro Kondoh7, Tomoki Kimura7, Naozumi Hashimoto1, Yoshinori Hasegawa1. 1. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. 2. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Electronic address: sakakoji@med.nagoya-u.ac.jp. 3. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan. 4. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Respiratory Medicine, Handa City Hospital, Handa, Aichi, Japan. 5. Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. 6. Department of Respiratory Medicine, Handa City Hospital, Handa, Aichi, Japan. 7. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
Abstract
INTRODUCTION: Pneumonitis is one of the immune-related adverse events of programmed death 1 (PD-1) inhibitors that sometimes cause lethal outcomes. Although some recent reports have described PD-1 inhibitors as more effective in non-small-cell lung cancer (NSCLC) patients with immune-related adverse events than in those without, few data are available on the prognosis of those treated with PD-1 inhibitors who developed immune-related pneumonitis (IRP). Additionally, the robust risk factors of IRP have not been well elucidated. PATIENTS AND METHODS: A retrospective review of patients with recurrent or advanced NSCLC who took a PD-1 inhibitor (nivolumab or pembrolizumab monotherapy) between January 2016 and March 2018 was undertaken. Radiologic findings such as unilateral infiltration were also defined as IRP as long as they were deemed relevant to PD-1 inhibitors. RESULTS: Twenty-seven (16%) of 170 patients developed IRP. Although 22 (81%) of 27 patients with IRP recovered with drug cessation with or without corticosteroid therapy, 8-week landmark analysis showed the overall survival after administration of the PD-1 inhibitor was significantly shorter in patients with IRP than in those without (8.7 vs. 23.0 months, P = .015). Patients with IRP tended to not receive next-line treatment and choose best supportive care after cessation of PD-1 inhibitor therapy. In the multivariate analysis, pembrolizumab (vs. nivolumab) and low serum albumin were independent risk factors for IRP. CONCLUSION: Development of IRP was correlated with poor prognosis in patients with NSCLC. Further study is necessary for establishing the best prediction and management strategies for IRP.
INTRODUCTION:Pneumonitis is one of the immune-related adverse events of programmed death 1 (PD-1) inhibitors that sometimes cause lethal outcomes. Although some recent reports have described PD-1 inhibitors as more effective in non-small-cell lung cancer (NSCLC) patients with immune-related adverse events than in those without, few data are available on the prognosis of those treated with PD-1 inhibitors who developed immune-related pneumonitis (IRP). Additionally, the robust risk factors of IRP have not been well elucidated. PATIENTS AND METHODS: A retrospective review of patients with recurrent or advanced NSCLC who took a PD-1 inhibitor (nivolumab or pembrolizumab monotherapy) between January 2016 and March 2018 was undertaken. Radiologic findings such as unilateral infiltration were also defined as IRP as long as they were deemed relevant to PD-1 inhibitors. RESULTS: Twenty-seven (16%) of 170 patients developed IRP. Although 22 (81%) of 27 patients with IRP recovered with drug cessation with or without corticosteroid therapy, 8-week landmark analysis showed the overall survival after administration of the PD-1 inhibitor was significantly shorter in patients with IRP than in those without (8.7 vs. 23.0 months, P = .015). Patients with IRP tended to not receive next-line treatment and choose best supportive care after cessation of PD-1 inhibitor therapy. In the multivariate analysis, pembrolizumab (vs. nivolumab) and low serum albumin were independent risk factors for IRP. CONCLUSION: Development of IRP was correlated with poor prognosis in patients with NSCLC. Further study is necessary for establishing the best prediction and management strategies for IRP.
Authors: Marco Russano; Alessio Cortellini; Raffaele Giusti; Alessandro Russo; Federica Zoratto; Francesca Rastelli; Alain Gelibter; Rita Chiari; Olga Nigro; Michele De Tursi; Sergio Bracarda; Stefania Gori; Francesco Grossi; Melissa Bersanelli; Lorenzo Calvetti; Vincenzo Di Noia; Mario Scartozzi; Massimo Di Maio; Paolo Bossi; Alfredo Falcone; Fabrizio Citarella; Francesco Pantano; Corrado Ficorella; Marco Filetti; Vincenzo Adamo; Enzo Veltri; Federica Pergolesi; Mario Alberto Occhipinti; Linda Nicolardi; Alessandro Tuzi; Pietro Di Marino; Serena Macrini; Alessandro Inno; Michele Ghidini; Sebastiano Buti; Giuseppe Aprile; Eleonora Lai; Marco Audisio; Salvatore Intagliata; Riccardo Marconcini; Davide Brocco; Giampiero Porzio; Marta Piras; Erika Rijavec; Francesca Simionato; Clara Natoli; Marcello Tiseo; Bruno Vincenzi; Giuseppe Tonini; Daniele Santini Journal: Cancer Immunol Immunother Date: 2021-08-31 Impact factor: 6.968