Immune checkpoint inhibitor-induced interstitial lung disease in non-small cell lung cancer patients with preexisting pulmonary emphysema or interstitial lung abnormalities.

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.