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- Title
Incidence and Risk Factors for Pneumonitis Associated With Checkpoint Inhibitors in Advanced Non-Small Cell Lung Cancer: A Single Center Experience.
- Authors
Altan, Mehmet; Soto, Felipe; Zhong, Linda L; Akhmedzhanov, Fechukwu O; Wilson, Nathaniel R; Zarifa, Abdulrazzak; Albittar, Aya A; Yang, Vincent; Lewis, Jeff; Rinsurongkawong, Waree; Jack Lee, J; Rinsurongkawong, Vadeerat; Zhang, Jianjun; Gibbons, Don L; Vaporciyan, Ara A; Jennings, Kristofer; Khawaja, Fareed; Faiz, Saadia A; Shannon, Vickie R; Shroff, Girish
- Abstract
Introduction: Immune checkpoint inhibitor (ICI) pneumonitis causes substantial morbidity and mortality. Estimates of real-world incidence and reported risk factors vary substantially. Methods: We conducted a retrospective review of 419 patients with advanced non-small cell lung cancer (NSCLC) who were treated with anti-PD-(L)1 with or without anti-CTLA-4 therapy. Clinical, imaging, and microbiological data were evaluated by multidisciplinary adjudication teams. The primary outcome of interest was grade ≥2 (CTCAEv5) pneumonitis. Clinicopathologic variables, tobacco use, cancer therapies, and preexisting lung disease were assessed for univariate effects using Cox proportional hazards models. We created multivariate Cox proportional hazards models to assess risk factors for pneumonitis and mortality. Pneumonitis, pneumonia, and progression were modeled as time-dependent variables in mortality models. Results: We evaluated 419 patients between 2013 and 2021. The cumulative incidence of pneumonitis was 9.5% (40/419). In a multivariate model, pneumonitis increased the risk for mortality (HR 1.6, 95% CI, 1.0-2.5), after adjustment for disease progression (HR 1.6, 95% CI, 1.4-1.8) and baseline shortness of breath (HR 1.5, 95% CI, 1.2-2.0). Incomplete resolution was more common with more severe pneumonitis. Interstitial lung disease was associated with higher risk for pneumonitis (HR 5.4, 95% CI, 1.1-26.6), particularly in never smokers (HR 26.9, 95% CI, 2.8-259.0). Conclusion: Pneumonitis occurred at a high rate and significantly increased mortality. Interstitial lung disease, particularly in never smokers, increased the risk for pneumonitis. This article examines the predisposing risk factors and incidence of pneumonitis in patients with non-small cell lung cancer undergoing immune checkpoint inhibitor therapy and explores the potential modifying effects of smoking history and preexisting lung disease.
- Subjects
TEXAS; RISK factors of pneumonia; LUNG cancer; PNEUMONIA; STATISTICS; IMMUNE checkpoint inhibitors; CONFIDENCE intervals; MULTIVARIATE analysis; NON-smokers; RETROSPECTIVE studies; ACQUISITION of data; INTERSTITIAL lung diseases; DISEASE incidence; TUMOR classification; RISK assessment; SEVERITY of illness index; MEDICAL records; RESEARCH funding; DESCRIPTIVE statistics; PROPORTIONAL hazards models; DISEASE complications
- Publication
Oncologist, 2023, Vol 28, Issue 11, pe1065
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1093/oncolo/oyad118