Pembrolizumab for Previously Untreated Patients with Advanced Non-small-cell Lung Cancer and Preexisting Interstitial Lung Disease

Abstract

Objective Pembrolizumab has benefited patients with advanced non-small-cell lung cancer (NSCLC) with a programmed death-ligand (PD-L)1 high expression, but little information is available regarding its safety for patients with interstitial lung disease (ILD). The aim of this study was to assess the efficacy and tolerability of pembrolizumab for patients with advanced NSCLC and preexisting ILD. Methods We retrospectively reviewed the medical records of five patients with advanced NSCLC and preexisting ILD who received pembrolizumab monotherapy in a first-line setting. Patients All patients had mild ILD and pulmonary emphysema with a forced vital capacity within the normal range. Pembrolizumab was administered at a dose of 200 mg/body on day 1 every 3 weeks. Results The overall response rate was 60%. Four patients developed pembrolizumab-induced lung injury, which was improved in all cases by corticosteroid therapy. One patient received pembrolizumab for two years, did not experience lung injury and achieved a complete response. Conclusion Pembrolizumab has a high risk of inducing lung injury in patients with preexisting ILD, although it may be very effective in NSCLC patients with a high PD-L1 expression, even concurrent with preexisting ILD. Further large-scale studies are needed to determine risk factors of pembrolizumab-induced lung injury in such patients.

Complete response of squamous cell carcinoma of the lung following treatment with pembrolizumab in an elderly patient: A case report

“…We were only able to find two previous case reports. 3,4 Similarly, a few cases show the effectiveness of nivolumab against lung cancer; and we found three such case reports. [5][6][7] In the CheckMate 057 trial, nivolumab achieved four points of CR out of 292 cases.…”

“…To the best of our knowledge, CR of NSCLC after treatment with pembrolizumab is extremely rare. We were only able to find two previous case reports 3,4 . Similarly, a few cases show the effectiveness of nivolumab against lung cancer; and we found three such case reports 5–7 .…”

Impact of treatment line on risks and benefits of immune checkpoint inhibitor in patients with advanced non-small cell lung cancer and interstitial lung disease: a systematic review and meta-analysis of cohort studies

“…In total, 319 records were screened and 300 articles were excluded based on their titles and abstracts. All investigators fully assessed the remaining 19 articles and agreed to include 17 eligible studies comprising 5,529 patients in the subsequent meta-analysis (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

“…In most studies, the median age was around 70 years (range, 63-78 years) and the treatment lines and regimen were described. Two studies described the first-line treatment of patients with pembrolizumab alone (18,25), while six studies described only the secondline treatment (12)(13)(14)19,23,26). Of the six studies, only nivolumab was administered in five studies (12)(13)(14)23,26), and atezolizumab in one study (19).…”

“…Although the safety and efficacy have been evaluated in a few prospective observational studies with a small number of cases and multiple retrospective observational studies (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), there is no consensus regarding the use of ICIs in NSCLC patients with pre-existing ILD. Thus, we performed a meta-analysis using the available reports to elucidate the risks and benefits of ICIs for advanced NSCLC patients with pre-existing ILD.…”