Aiben Huang1, Yang Xu2, Xuelei Zang3, Jie Gao4, Mei Xie5, Chongchong Wu6, Xiaoli Sun1, Xidong Ma2, Hui Deng1, Jialin Song7, Fangping Ren1, Li Pang1, Jin Qian1, Zhaofeng Yu8, Shiyu Wan8, Yuanyuan Chen8, Lei Pan9, Guanglei Zhuang10, Sanhong Liu11, Xinying Xue12. 1. Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China. 2. Department of Respiratory and Critical Care, Chinese PLA General Hospital, Beijing, China. 3. Center of Clinical Laboratory Medicine, the first Medical Centre, Chinese PLA General Hospital, Beijing, China. 4. Department of Pathology, Chinese PLA General Hospital, Beijing, China. 5. Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China. 6. Department of Radiology, Chinese PLA General Hospital, Beijing, China. 7. Department of Respiratory Medicine, Weifang Medical University, Weifang, China. 8. School of Medicine, Peking University, Beijing, China. 9. Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China. leipan2010@163.com. 10. Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. zhuangguanglei@163.com. 11. Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China. liush@shutcm.edu.cn. 12. Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China. xuexinying2988@bjsjth.cn.
Abstract
BACKGROUND: Immunotherapy is becoming a standard of care for non-small cell lung cancer (NSCLC). Checkpoint inhibitor-associated pneumonia (CIP) is a rare and potentially life-threatening event that can occur at any time during tumor immunotherapy. However, there may be differences in the radiological patterns and prognosis of CIP during different periods. This study aimed to investigate the radiographic features and prognosis of early- and late-onset immune-related pneumonitis. METHODS: We retrospectively analyzed the clinical data of 677 NSCLC patients receiving immunotherapy to identify 32 patients with CIP, analyzed the clinical and radiographic data, and summarized the radiological features and prognosis of early- and late-onset CIP. RESULTS: CIP had an incidence of 4.7%, a median onset time of 10 weeks, and a mortality of 28.1%. Among these, CIP included 14 early-onset cases, where grade ≥ 3 CIP accounted for 92.9%, main radiographic pattern was organizing pneumonia (OP)-like pattern, and mortality was 50.0%. We also identified 18 late-onset CIPs, where grade ≥ 3 CIP accounted for 50.0%, main radiographic pattern was nonspecific interstitial pneumonia (NSIP)-like pattern, and mortality was 11.1%. The overall survival rate of the early-onset group was significantly lower than that of the late-onset group (P < 0.05). CONCLUSION: Early-onset CIP cases were higher in the Common Terminology Criteria for Adverse Events (CTCAE v5.0) grade and mainly presented with an OP-like radiographic pattern; whereas, late-onset CIP cases were lower in CTCAE grade and mainly presented with an NSIP-like radiographic pattern. Finally, the prognosis of the early-onset CIP group was poorer than that of the late-onset CIP group. We believe that this study will be helpful for clinicians for making early diagnosis and deciding treatment modalities for patients with CIP.
BACKGROUND: Immunotherapy is becoming a standard of care for non-small cell lung cancer (NSCLC). Checkpoint inhibitor-associated pneumonia (CIP) is a rare and potentially life-threatening event that can occur at any time during tumor immunotherapy. However, there may be differences in the radiological patterns and prognosis of CIP during different periods. This study aimed to investigate the radiographic features and prognosis of early- and late-onset immune-related pneumonitis. METHODS: We retrospectively analyzed the clinical data of 677 NSCLCpatients receiving immunotherapy to identify 32 patients with CIP, analyzed the clinical and radiographic data, and summarized the radiological features and prognosis of early- and late-onset CIP. RESULTS:CIP had an incidence of 4.7%, a median onset time of 10 weeks, and a mortality of 28.1%. Among these, CIP included 14 early-onset cases, where grade ≥ 3 CIP accounted for 92.9%, main radiographic pattern was organizing pneumonia (OP)-like pattern, and mortality was 50.0%. We also identified 18 late-onset CIPs, where grade ≥ 3 CIP accounted for 50.0%, main radiographic pattern was nonspecific interstitial pneumonia (NSIP)-like pattern, and mortality was 11.1%. The overall survival rate of the early-onset group was significantly lower than that of the late-onset group (P < 0.05). CONCLUSION: Early-onset CIP cases were higher in the Common Terminology Criteria for Adverse Events (CTCAE v5.0) grade and mainly presented with an OP-like radiographic pattern; whereas, late-onset CIP cases were lower in CTCAE grade and mainly presented with an NSIP-like radiographic pattern. Finally, the prognosis of the early-onset CIP group was poorer than that of the late-onset CIP group. We believe that this study will be helpful for clinicians for making early diagnosis and deciding treatment modalities for patients with CIP.
Authors: Rubens Barros Costa; Al Benson; Vahid Yaghmai; Ricardo L B Costa; Haijun Zhou; Amir Behdad; Jason B Kaplan; Maureen Sadim; Sarah Talamantes; Aparna Kalyan Journal: Case Rep Oncol Med Date: 2018-04-01