Risk factors and clinical outcomes of immune checkpoint inhibitor-related pneumonitis in patients with advanced non-small cell lung cancer：A single center experience

Abstract

Abstract Purpose Immune checkpoint inhibitors (ICIs) can lead to pneumonitis, a potentially fatal complication. Identifying patients at risk of immune checkpoint inhibitor-related pneumonitis (CIP) prior to starting ICIs treatment is essential for managing CIP. We conducted this study with the purpose of determining the prognosis and risk factors for CIP. Methods In this study, 360 patients with non-small cell lung cancer (NSCLC) who underwent anti-programmed cell death-1/-ligand 1 (PD-1/PD-L1) inhibitors for at least one dose from 2019 to 2022 at Hubei Cancer Hospital were included. Risk factors correlated with CIP and mortality were assessed by regression analyses. Kaplan-Meier estimates were applied to examine survival times. Results There were 360 patients enrolled, the incidence of CIP was 8.6% (31/360). Of all CIP, 12 were graded 3 or higher based on the Common Terminology Criteria for Adverse Events (CTCAE 5.0). The median time to CIP onset was 90 (interquartile range [IQR], 37–160) days. A significant association for CIP was found with body mass index (BMI) (p=0.004) and chronic obstructive pulmonary disease (COPD) (p=0.003) on univariate and multivariate logistic regression analyses. In patients who developed CIP and those who did not, the progression free survival and overall survival were not statistically different. Additionally, early-onset CIP had a higher risk of mortality (p=0.039, HR=3.677, 95% CI, 1.071-12.554), after adjusting for sex, age and rechallenge. Conclusion Increased BMI and COPD were strongly associated with CIP. Early-onset CIP significantly increased the risk of mortality.