Clinical significance of interstitial lung abnormalities and immune checkpoint inhibitor‐induced interstitial lung disease in patients with non‐small cell lung cancer

Abstract

BackgroundInterstitial lung abnormalities (ILAs) are known to be a risk of drug-induced pneumonitis. However, there are few reports on the relationship between ILAs and immune checkpoint inhibitor-related interstitial lung disease (ICI-ILD). We retrospectively investigated the clinical signi cance of ILAs in patients with nonsmall cell lung cancer (NSCLC) receiving ICI. MethodsWe de ned ILAs as nondependent abnormalities affecting more than 5% of any lung zone, including ground-glass or diffuse centrilobular nodularities, traction bronchiectasis, honeycombing, and nonemphysematous cysts. Early-onset ICI-ILD was de ned as developing within 3 months after the initiation of ICI administration. ResultsOf 264 patients with advanced NSCLC, 57 patients (21.6%) had ILAs (43 brotic and 14 non brotic ILAs).The difference between the incidence of ICI-ILD in patients with or without ILAs was not signi cant. Of 193 patients treated by ICI monotherapy, 18 (9.3%) developed early-onset ICI-ILD. Among patients receiving ICI monotherapy, the incidence of early-onset ICI-ILD was signi cantly higher in patients with than in patients without non brotic ILAs. ConclusionThe presence of non brotic ILAs is a signi cant risk for early-onset ICI-ILD in patients with NSCLC undergoing ICI monotherapy. Clinicians should be aware of ILAs, especially non brotic ILAs, before administering ICIs to lung cancer patients.warranted to validate the present ndings. In conclusion, the presence of non brotic ILAs was a signi cant risk factor for early-onset ICI-ILD in patients about to undergo ICI monotherapy. The presence of ILAs is more likely to be associated with lung cancer then the absence of ILAs, and early-onset ICI-ILD can interfere with the treatment of lung cancer and can be life-threatening. Clinicians should bear in mind the possible presence of ILAs, especially non brotic ILAs, in patients with lung cancer, before they decide to administer ICIs.

Clinical outcomes of interstitial lung abnormalities: a systematic review and meta-analysis

“…In nine studies on cancer treatment-related complications 20 , 22 , 27 – 33 , the prevalence of ILA ranged from 4 to 38%, and the follow-up periods varied from 0 to 12 years. Four studies adhered to the Fleischner Society definition, whereas the others had minor differences in ILA criteria.…”

“…Four studies adhered to the Fleischner Society definition, whereas the others had minor differences in ILA criteria. Four studies examined RP 27 , 28 , 32 , 33 , and another four studied ICI-ILD 20 , 29 – 31 . Notably, a single study focused on PPC 22 , which precluded the possibility of a comprehensive meta-analysis on PPC.…”

“…Several studies have reported an association between ILA and various clinical outcomes, including mortality, development of lung cancer, changes in lung function, and disease progression 3 , 16 – 19 . Additionally, there is increasing awareness regarding the influence of ILA on cancer treatment-related complications, including radiation therapy, immune checkpoint inhibitors (ICI), and surgery 20 – 22 . In 2020, the Fleischner Society standardized the definition of ILA as incidental findings on CT imaging, characterized by nondependent interstitial abnormalities involving more than 5% of any lung zone 2 .…”

Pre-Existing Interstitial Lung Abnormalities in Patients with Head and Neck Squamous Cell Carcinoma and Their Follow Up after Therapy

“…Research on the non-small lung cell carcinoma (NSCLC) cohort revealed that individuals with interstitial lung changes had a higher risk of developing immune-related pneumonia following immunotherapy [ 37 ]. Additionally, in patients with NSCLC receiving immune checkpoint inhibitor monotherapy, the presence of non-fibrotic ILAs was noted as a significant risk factor for early onset immune checkpoint inhibitor-induced interstitial lung disease (ICI-ILD) [ 38 ]. In stage III of NSCLC patients who have received definitive concurrent chemoradiotherapy but still have unresectable disease, pretreatment fibrotic ILA has been shown to be strongly related with symptomatic radiation pneumonitis and poor survival [ 39 ].…”