Lung cancer (Amsterdam, Netherlands) · 2025
Immune checkpoint inhibitor-induced interstitial lung disease in non-small cell lung cancer patients with preexisting pulmonary emphysema or interstitial lung abnormalities.
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Chen Xi, Huan Caijuan, Yang Piao, He Mengye, Wang Ruiping, Zhou Jianying, Zhou Jianya
Аннотация
BACKGROUND: Immune checkpoint inhibitor-induced interstitial lung disease (ICI-ILD) is a serious adverse event. While interstitial lung abnormalities (ILA) are known risk factors, the role of preexisting pulmonary emphysema remains controversial.
PATIENTS AND METHODS: We enrolled patients with advanced or recurrent NSCLC who received anti-PD-1 antibody at our institution between October 2020 and October 2022. Clinical characteristics, radiographic features, time of onset, and outcomes of ICI-ILD were compared between patients with preexisting emphysema and/or ILA and those without these conditions.
RESULTS: Among 757 patients, the overall incidence of ICI-ILD was 10.4 %. The incidence in patients with emphysema alone was significantly higher than in those without emphysema or ILA (14.1 % vs. 4.4 %, P < 0.001). The incidence in patients with ILA alone showed a trend toward higher than in those without both conditions (10.7 % vs. 4.4 %, P = 0.054). Notably, a numerically higher incidence of ICI-ILD was observed in patients with severe emphysema (E score ≥ 3; 31.3 % vs. E score = 1-2; 14.7 %, P = 0.072) and in those with baseline honeycombing compared to other ILA subtypes (41.7 % vs. 13.9 %, P = 0.056). Moreover, the presence of baseline extensive ILA was associated with a significantly higher incidence than limited ILA (42.3 % vs. 9.9 %, P < 0.001). Multivariate analysis identified preexisting emphysema (Odds Ratio [OR], 2.81; 95 % CI, 1.60-4.92; P < 0.001), preexisting ILA (OR, 1.98; 95 % CI, 1.13-3.49; P = 0.018), age (OR, 1.04; 95 % CI, 1.01-1.08; P = 0.008), and prior thoracic radiotherapy (OR, 4.10; 95 % CI, 2.12-7.94; P < 0.001) as independent risk factors for ICI-ILD.
CONCLUSION: Preexisting emphysema or ILA significantly increases the risk of ICI-ILD in NSCLC patients. Close monitoring is warranted, particularly in patients with severe emphysema, honeycombing, or extensive ILA.
PATIENTS AND METHODS: We enrolled patients with advanced or recurrent NSCLC who received anti-PD-1 antibody at our institution between October 2020 and October 2022. Clinical characteristics, radiographic features, time of onset, and outcomes of ICI-ILD were compared between patients with preexisting emphysema and/or ILA and those without these conditions.
RESULTS: Among 757 patients, the overall incidence of ICI-ILD was 10.4 %. The incidence in patients with emphysema alone was significantly higher than in those without emphysema or ILA (14.1 % vs. 4.4 %, P < 0.001). The incidence in patients with ILA alone showed a trend toward higher than in those without both conditions (10.7 % vs. 4.4 %, P = 0.054). Notably, a numerically higher incidence of ICI-ILD was observed in patients with severe emphysema (E score ≥ 3; 31.3 % vs. E score = 1-2; 14.7 %, P = 0.072) and in those with baseline honeycombing compared to other ILA subtypes (41.7 % vs. 13.9 %, P = 0.056). Moreover, the presence of baseline extensive ILA was associated with a significantly higher incidence than limited ILA (42.3 % vs. 9.9 %, P < 0.001). Multivariate analysis identified preexisting emphysema (Odds Ratio [OR], 2.81; 95 % CI, 1.60-4.92; P < 0.001), preexisting ILA (OR, 1.98; 95 % CI, 1.13-3.49; P = 0.018), age (OR, 1.04; 95 % CI, 1.01-1.08; P = 0.008), and prior thoracic radiotherapy (OR, 4.10; 95 % CI, 2.12-7.94; P < 0.001) as independent risk factors for ICI-ILD.
CONCLUSION: Preexisting emphysema or ILA significantly increases the risk of ICI-ILD in NSCLC patients. Close monitoring is warranted, particularly in patients with severe emphysema, honeycombing, or extensive ILA.