CHEST Guidelines-Immune-Checkpoint-Inhibitor-Related-Pneumonitis-in

Immune-Checkpoint-Inhibitor-Related-Pneumonitis-in

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This study, conducted by William T. Atchley and colleagues, examines the incidence, risk factors, and management of immune checkpoint inhibitor-related pneumonitis (ICI-P) among lung cancer patients treated at six healthcare centers in North Carolina. Immune checkpoint inhibitors (ICIs) are increasingly used to treat non-small cell lung cancer (NSCLC) and small cell lung cancer, known for associated immune-related adverse events like ICI-P, which can lead to significant morbidity.<br /><br />The retrospective study included 315 lung cancer patients treated with nivolumab, pembrolizumab, or a combination of ipilimumab and nivolumab from January 2004 to July 2017. Among them, the incidence of ICI-P was found to be 9.5%, higher than previous clinical trial results. ICI-P was often severe, with a high mortality rate, as 27% of affected patients died during ongoing treatment. Key risk factors identified for ICI-P included baseline fibrosis on chest CT scans, chronic obstructive lung disease, and pembrolizumab treatment. Notably, the study suggested that the presence of chronic pulmonary diseases significantly increases the risk of ICI-P.<br /><br />Management practices varied across centers, and this cohort had a higher incidence of ICI-P when compared to clinical trial populations, likely due to looser selection criteria and the presence of chronic lung conditions in real-world settings. Results also indicated that pembrolizumab, compared to nivolumab, was independently associated with a higher risk of ICI-P.<br /><br />The study highlights the need for further research to understand better and mitigate the risks associated with ICI treatments in lung cancer patients, especially those with existing chronic pulmonary issues. It calls for potentially increased pre-treatment screening and collaboration with pulmonary specialists to reduce ICI-P risk. This real-world analysis of ICI-P provides insights into improving clinical practices and patient outcomes for those undergoing ICI therapy for lung cancer.

Keywords

immune checkpoint inhibitor-related pneumonitis

lung cancer

immune checkpoint inhibitors

non-small cell lung cancer

small cell lung cancer

risk factors

pembrolizumab

nivolumab

chronic pulmonary diseases

real-world analysis