Risk of pneumonitis in non-small cell lung cancer patients with preexisting interstitial lung diseases treated with immune checkpoint inhibitors: a nationwide retrospective cohort study

The impact of pre-existing interstitial lung disease on radiation and checkpoint inhibitor pneumonitis in lung cancer patients: a systematic review and meta-analysis

Background

Current research presents conflicting evidence on whether pre-existing interstitial lung disease (ILD) serves as a risk factor for radiation pneumonitis (RP) and checkpoint inhibitor pneumonitis (CIP) in patients with lung cancer.

Objectives

This study aims to systematically evaluate the impact of pre-existing ILD on the risk of developing RP and CIP in lung cancer patients.

Design

A systematic review and meta-analysis was conducted using a random-effects model.

Data sources and methods

PubMed, Embase, and Web of Science were searched to identify relevant studies. A random-effects model was applied to estimate the risk and incidence of RP and CIP in lung cancer patients with pre-existing ILD compared to those without ILD. Sensitivity analyses were performed to assess the robustness of the pooled findings, and potential publication bias was evaluated using Begg's and Egger's tests.

Results

A total of 12 studies involving 2576 patients were included in the RP risk assessment, while 29 studies with 8037 patients were analyzed for CIP risk. The pooled results indicated that pre-existing ILD significantly increased the risk of developing any-grade RP (odds ratio (OR): 3.63, 95% confidence interval (CI): 2.26-5.83) and severe RP (OR: 6.10, 95% CI: 2.68-13.86) in lung cancer patients. Subgroup analyses identified stereotactic body radiation therapy as the modality associated with the lowest risk of any-grade RP in these patients. Similarly, pre-existing ILD was associated with a significantly higher risk of any-grade CIP (OR: 3.86, 95% CI: 2.65-5.61) and severe CIP (OR: 3.24, 95% CI: 2.07-5.07), with anti-programmed cell death 1 therapies showing the highest CIP risk.

Conclusion

Pre-existing ILD markedly increases the risk of both RP and CIP in lung cancer patients. These findings underscore the critical importance of thorough ILD evaluation and the development of personalized treatment strategies to mitigate these risks prior to initiating cancer therapy.

Are immune checkpoint inhibitors safe and effective in lung cancer patients with pre-existing interstitial lung disease?

Aim: This study aims to clarify the efficacy and adverse effects of immune checkpoint inhibitors (ICIs) in the lung cancer patients with a history of interstitial lung disease (ILD). Methods: From the inception of the database to 4 April 2023, we systematically searched the four databases. Results: The objective remission rate, disease control rate, incidence of immune-associated pneumonitis (ICIP) in the combined ILD group were significantly higher than those in the non-combined ILD group. There were no significant differences between the two groups in progression-free survival, overall survival, renal insufficiency, thyroid dysfunction and gastrointestinal toxicity. Conclusion: Generally, a pre-existing ILD history can increase the efficacy and incidence of ICIs' adverse reactions. Therefore, ICIs should be administered with caution.

Lack of Association Between Immunotherapy and Improvement of Survival for Non-small Cell Lung Cancer Patients With Hemodialysis: A Nationwide Retrospective Cohort Study

BACKGROUND

The number of patients undergoing hemodialysis continues to increase globally, and the incidence of cancer is high among these patients. Immune checkpoint inhibitors are widely used in patients with advanced cancer, especially non-small cell lung cancer (NSCLC); however, their effectiveness in hemodialysis patients is poorly documented.

METHODS

This retrospective cohort study used data from a nationwide database. Patients diagnosed with NSCLC, undergoing hemodialysis, and who started chemotherapy between September 2008 and January 2023 were included. In the intention to treat (ITT) analysis, patients were divided into immune checkpoint inhibitor (ICI) and conventional chemotherapy group, and in the chronological analysis, patients were divided into 2 groups before and after ICI approval. Overall survival (OS) was analyzed using the Kaplan-Meier method with log-rank tests and Cox proportional hazards analyses. A propensity score approach was applied to address confounding factors, and analyses were performed by weighting each patient with the inverse of the estimated propensity score.

RESULTS

We identified 322 and 389 patients in the ITT and chronological analyses respectively. In both analyses, there were no notable difference of OS between 2 groups (P values by log-rank test 0.933 and 0.248, respectively). The hazard ratios for OS were 0.980 (95% confidence interval [CI]: 0.678-1.415) in the ITT analysis and 0.805 (95% CI: 0.531-1.219) in the chronological analysis.

CONCLUSION

The ICI treatment and approval were not significantly associated with improvement of survival in patients with NSCLC undergoing hemodialysis.

Immune Checkpoint Inhibitor Is Associated with Improved Survival in Advanced Non-small Cell Lung Cancer Occurring in Patients with Autoimmune Disease

The use of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). However, clinical trials often exclude those with a history of autoimmune diseases (ADs) because of concerns regarding immune-related adverse events. Therefore, the efficacy of ICIs in advanced NSCLC patients with ADs should be evaluated. This study used administrative claims data from advanced treatment centers in Japan and identified patients with advanced NSCLC who began chemotherapy between December 2016 and January 2023. The patients were divided into four groups based on the presence of ADs and types of chemotherapy received. The association between ICI therapy and overall survival in the subgroups with or without ADs, and the association between the presence of AD and overall survival in patients who received ICI therapy and conventional chemotherapy, were analyzed using Cox proportional hazard regression, including therapy and presence of ADs and their interaction as covariates. These results were obtained using the inverse probability of treatment weighting. ICI therapy had a hazard ratio (95% confidence interval) for death in the subgroup of AD and non-AD patients of 0.88 (0.84-0.92) and 0.83 (0.71-0.97), respectively (p = 0.459 for interaction). For some specific ADs, including type 1 diabetes mellitus, the association between ICI therapy and decreased mortality was not observed. In conclusion, our study showed comparable associations between ICI therapy and reduced mortality in AD and non-AD subgroups of patients with advanced NSCLC. However, therapy strategies tailored to each AD type and thorough discussions regarding the risk-benefit profile are crucial.