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Archive > Volume 29 Issue 11 > 2022,29(11):995-1001. DOI:10.3872/j.issn.1007-385X.2022.11.006 Prev Next
Clinical Research
Characteristics and risk factors of immune-related adverse events and pneumonitis associated with immune checkpoint inhibitors in the treatment of non-small cell lung cancer
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Abstract:
Objective: To investigate the clinical characteristics and risk factors of immune-related adverse events (irAEs) and immune checkpoint inhibitor-related pneumonitis (ICI-P) in non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs). Methods: The baseline characteristics, treatment details and data on the occurrence of irAE and ICI-P from general information and clinical characteristics of 114 NSCLC patients who received at least 1 ICI treatment at the Department of Thoracic Oncology, Shanxi Bethune Hospital during January 2019 and December 2021 were retrospectively analyzed. The relationship between patients' clinical characteristics and irAE as well as ICI-P was investigated, and the risk factors for the occurrence of ICI-P were also analyzed. Moreover, the characteristics and treatment outcomes of patients with ICI-P were also observed. Results: There were 68 irAEs occurred in 48 (42.11%) out of 114 NSCLC patients treated with ICIs, with the incidences of overall irAE and severe irAEs of 59.65% and 9.65%, respectively. The organs associated with the incidence of irAE in the descending order (only the top four are listed) were gastrointestinal system >respiratory system >skin > endocrine system; and the ICIs associated with the incidence of irAE were sindilizumab>dulcolizumab>carrelixumab=Pabrolizumab. Age in clinical characteristics was associated with the occurrence of irAE. 15 patients developed ICI-P, with an overall incidence of 13.16%, accounting for 31.25% of all irAE patients, of whom 4 were severe, accounting for 8.33% of the number of irAE and 26.66% of the number of ICI-P. The incidence of ICI-P was higher in patients with combination therapy than those with monotherapy (73.33% vs 26.67%), and the incidence of ICI-P was the highest in patients treated with Sindilizumab (60% of ICI-P cases). A history of smoking was a risk factor for ICI-P. Most of the patients with ICI-P presented with common respiratory symptoms, and all of the severe cases were elderly smokers with severe symptoms and fibrosis or a ground glass appearance on imaging. Only one case did not discontinue ICI, and the rest suspended or delayed ICI and received corticosteroid therapy with good outcomes. Conclusion: The incidence of irAE in ICI-treated NSCLC is high and predominantly in elderly patients. About 1/3 of patients with irAE develop ICI-P and about 1/4 of ICI-P is severe. A history of smoking is a risk factor for the development of ICI-P.
Keywords:
non-small cell lung cancer (NSCLC) ; immune checkpoint inhibitor (ICI) ; immune-related adverse effect (irAE) ; immune checkpoint inhibitor-related pneumoniti (ICI-P) ; incidence ; risk factor
