Pneumonitis in Non–Small Cell Lung Cancer Patients Receiving Immune Checkpoint Immunotherapy: Incidence and Risk Factors

Abstract

Checkpoint inhibitor pneumonitis (CIP) is an immunerelated adverse event that can occur after initiation of anti-programmed death 1/programmed death ligand 1 immune checkpoint inhibitor (ICI) therapy for the treatment of multiple malignancies, including NSCLC. However, the incidence of CIP has not been previously examined in a population that included both trial-enrolled and non-trialenrolled patients with advanced NSCLC. Furthermore, risk factors and other clinical characteristics associated with CIP severity are not known. In this study, we retrospectively examined clinical characteristics, incidence, and risk factors for CIP in a cohort of 205 patients with NSCLC, all of whom received anti-programmed death 1/programmed death ligand 1 ICIs. Our results demonstrate a higher incidence of CIP (19%) than previously reported in clinical trials (3%-5%). Our data also suggest that tumor histologic type may be a risk factor for CIP development. We observed a wide range of time to onset of CIP (median 82 days), with high morbidity and mortality associated with higher-grade CIP regardless of degree of immunosuppression. Our data provide new insight into the epidemiology and clinical

Checkpoint Inhibitor Pneumonitis — Real-World Incidence and Risk

“…4 From this meta-analysis, it was clear that the incidence of CIP is higher in advanced NSCLC compared to other solid tumors (any grade: 4.1%; grade 3-5: 1.8%).Presentation of CIP is notoriously nonspecific, ranging from asymptomatic disease to cough, dyspnea, fever, chest pain, and in severe cases, hypoxia and respiratory distress in the setting of radiological changes. 5 As failure to recognize or misdiagnosis of CIP can lead to potential fatal sequelae, improved recognition and understanding of this toxicity is greatly needed.In this issue of the Journal of Thoracic Oncology, Suresh et al 6 address the incidence and risk factors associated with CIP in a retrospective cohort of 205 advanced NSCLC patients treated over a 10-year period in an academic center. Notably, all cases of CIP were determined by multidisciplinary team consensus as to exclude patients with disease progression or infection.…”

“…All patients received first-line steroid therapy, resulting in improvement or complete resolution of CIP in 56% (n ¼ 22 of 39) of cases. Nine cases of steroid-refractory CIP were identified, with clinical response in 75% (n ¼ 3 of 4) of patients administered second-line immunosuppressive agents.Previously thought to be an uncommon immunemediated toxicity, Suresh et al 6 highlight a real world experience of CIP. With increased adoption of ICI agents into standard practice, the authors report an incremental increase in CIP incidence over the 10-year study period, certainly reflective of greater physician awareness and pharmacovigilance.…”

“…In this issue of the Journal of Thoracic Oncology, Suresh et al 6 address the incidence and risk factors associated with CIP in a retrospective cohort of 205 advanced NSCLC patients treated over a 10-year period in an academic center. Notably, all cases of CIP were determined by multidisciplinary team consensus as to exclude patients with disease progression or infection.…”

Immune-Related Adverse Events: Pneumonitis

“…Rates of pneumonitis may be higher when considering patients being treated outside the controlled context of clinical trials. In a single center study of 204 patients that included both clinical-trial-enrolled and non-clinical-trialenrolled patients with NSCLC, the incidence of any-grade pneumonitis was 19% and high-grade pneumonitis was 11% [130]. The median time of progression to pneumonitis was 6.3 months after starting immunotherapy.…”

Approach to Peribronchovascular Disease on CT

“…Organzing pneumonia is a common pattern on CT identified with immunotherapy for cancer. 40 Organizing pneumonia appears as consolidation and ground-glass opacities. A peribronchovascular and/ or subpleural distribution is reported in approximately 53%-63% of patients with cryptogenic organizing pneumonia ( Fig.…”