Treatment-associated lung inflammation in NSCLC increased with ICIs
medwireNews: The rate of treatment-associated pneumonitis among patients with advanced non-small-cell lung cancer (NSCLC) is higher with immune checkpoint inhibitor (ICI) therapy than chemotherapy, data suggests.
This difference was seen particularly in clinical trials but also in a real-world setting, emphasized Qi Liu (US Food and Drug Administration, Silver Spring, Maryland) who presented the findings at the 2020 AACR Virtual Annual Meeting I.
She reported that among a pooled cohort of 6491 advanced NSCLC patients from eight clinical trials, pneumonitis developed in 4.3% of 3723 patients treated with ICIs, with or without chemotherapy, compared with 1.0% of 2768 treated with chemotherapy.
Liu and team found “a similar trend” among 1262 real-world patients identified by chart review, although “the distance is smaller,” she noted.
For this group, the rates of treatment related-pneumonitis were 3.3% and 2.3% among the 615 patients treated with ICIs and the 647 treated with chemotherapy, respectively.
In both the clinical trial and real-world cohorts, a medical history of pneumonitis increased the risk for developing treatment-associated pneumonitis, regardless of treatment type, Liu reported.
Among 30 ICI-treated patients with a history of pneumonitis in the clinical trial cohort, 16.7% developed treatment-associated pneumonitis, compared with 4.4% of 3693 without a history. The rates for chemotherapy-treated patients were 11.1% of 18 with a medical history versus 1.0% of 2750 without.
For patients in the real-world setting, the rates were 14.3% among 21 ICI-treated and 8.3% among 12 chemotherapy-treated patients with a history of pneumonitis versus a respective 2.9% of 594 and 2.2% of 635 without.
In all cases the increased risk associated with a history of pneumonitis was significant, the only exception being for chemotherapy-treated patients in the real-world setting.
Liu noted that “most patients with past medical history of pneumonitis or [treatment-associated pneumonitis] in the real world data sample received prior radiation therapy.”
And commenting on the results, discussant Jarushka Naidoo (Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA) said that “the overall proportion of those with a prior history of pneumonitis in the clinical trial group is far lower than the real-world group, which again may suggest that the causes for a prior history of pneumonitis may have been different in the clinical trial patients than the real-world patients.”
To conclude, Liu said that the aim is to “further evaluate potential predictors of pneumonitis,” including looking at different therapeutic options (such as tyrosine kinase inhibitors) and different healthcare systems, additional real-world data groups, and patients with different medical histories including a record of chest radiation and infectious pneumonitis.
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