Immune Checkpoint Inhibitor Pneumonitis: Assessing Risk Factors in Patients With Lung Cancer

By: Chris Schimpf, BS
Posted: Wednesday, February 14, 2024

The results of a study published in JNCCN–Journal of the National Comprehensive Cancer Network suggest that prior chest radiation and preexisting interstitial abnormalities on chest CT are strong independent risk factors for pneumonitis among patients with lung cancer treated with immune checkpoint inhibitors. Citing the potentially life-threatening nature of this complication, Kevin Ho, MD, of The Ohio State University Wexner Medical Center, Columbus, and colleagues noted that these findings highlight a possible need for closer observation of patients with these particular risk factors.

“Given the increasing numbers of patients being offered treatment with immune checkpoint inhibitors for lung cancer, identifying potential patient-specific risk factors for the development of immune checkpoint inhibitor pneumonitis is essential to informing clinical decision-making and monitoring,” the investigators stated.

A total of 471 patients with lung cancer who received at least one dose of immune checkpoint inhibitors at The Ohio State University between 2015 and the end of 2020 were included in the single-center, retrospective cohort study. The researchers reported that 402 of the participants had non–small cell lung cancer (NSCLC), 69 had small cell lung cancer, and 39 (8%) in the overall cohort developed immune checkpoint inhibitor pneumonitis.

The investigators reported that preexisting interstitial abnormalities (hazard ratio [HR] = 8.91; 95% confidence interval [CI] = 4.69–16.92; P < .001) and prior chest radiation (HR = 2.81; 95% CI = 1.50–5.28; P = .001) were both significantly associated with immune checkpoint inhibitor pneumonitis on univariate analysis. On multivariable analyses, they reported that interstitial abnormalities remained a strong independent risk factor for immune checkpoint inhibitor pneumonitis when controlling for chest radiation and type of immunotherapy (HR = 9.77; 95% CI = 5.17–18.46; P < .001). Finally, they observed that among patients with immune checkpoint inhibitor pneumonitis (n = 39), those with grade 3 to 5 pneumonitis had worse overall survival than those with grade 1 or 2 (P = .001).

Disclosure: For full disclosures of the study authors, visit jnccn.org.

JNCCN–Journal of the National Comprehensive Cancer Network

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