학술논문
Incidence and Risk Factors for Pneumonitis Associated With Checkpoint Inhibitors in Advanced Non-Small Cell Lung Cancer: A Single Center Experience.
Document Type
Academic Journal
Author
Altan M; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Soto F; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Zhong LL; Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Akhmedzhanov FO; Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Wilson NR; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Zarifa A; Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Albittar AA; Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Yang V; Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Lewis J; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Rinsurongkawong W; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Jack Lee J; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Rinsurongkawong V; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Zhang J; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Gibbons DL; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Vaporciyan AA; Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Jennings K; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Khawaja F; Department of Infectious Disease, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Faiz SA; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Shannon VR; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Shroff G; Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Godoy MCB; Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Daver NG; Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Gandhi S; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Mendoza TR; Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Naing A; Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Daniel-MacDougall C; Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Heymach JV; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Sheshadri A; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 9607837 Publication Model: Print Cited Medium: Internet ISSN: 1549-490X (Electronic) Linking ISSN: 10837159 NLM ISO Abbreviation: Oncologist Subsets: MEDLINE
Subject
Language
English
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.
(© The Author(s) 2023. Published by Oxford University Press.)
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.
(© The Author(s) 2023. Published by Oxford University Press.)