Impact of interstitial lung disease associated with immune checkpoint inhibitors on prognosis in patients with non-small-cell lung cancer

• Published in: Cancer chemotherapy and pharmacology Vol. 87; no. 2; pp. 251 - 258
• Main Authors: Yamagata, Akira, Yokoyama, Toshihide, Fukuda, Yasushi, Ishida, Tadashi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2021; Springer Nature B.V
• Subjects: Alveoli; Cancer Research; Cancer therapies; Chemotherapy; Damage patterns; Disease control; Immune checkpoint inhibitors; Immunotherapy; Lung cancer; Lung diseases; Medical imaging; Medicine; Medicine & Public Health; Non-small cell lung carcinoma; Oncology; Original Article; Pharmacology/Toxicology; Pneumonia; Prognosis; Small cell lung carcinoma; Non-small-cell lung cancer; Immune checkpoint inhibitors; Pneumonitis; Prognosis; Immune-related adverse event; Interstitial lung disease
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-020-04205-x

Purpose Immune checkpoint inhibitor-associated interstitial lung disease (ICI-ILD) is a serious immune-related adverse event. We aimed to evaluate the impact of ICI-ILD severity and imaging patterns or post-ILD cancer therapy on prognosis in patients with non-small-cell lung cancer (NSCLC). Methods We retrospectively analysed NSCLC patients who developed ICI-ILD in our institution between January 2016 and March 2019. The primary objective was to report prognosis following onset of ICI-ILD, stratified by severity grade or imaging pattern. The secondary objective was the analysis of cancer therapy after ICI-ILD. Results Among 222 patients treated with ICI, 27 (12.2%) developed ICI-ILD. No trend for different prognosis depending on severity grade was seen unless ICI-ILD was fatal. Most patients (91.3%) with organising pneumonia (OP) or nonspecific interstitial pneumonia pattern on imaging showed grade 1 or 2, while all patients with a diffuse alveolar damage (DAD) pattern showed grade 3 or higher, and one reached grade 5. Among patients who overcame ICI-ILD, eight patients (30.8%) have been followed up without chemotherapy because of long-term disease control and seven had shown an OP pattern on imaging at onset of ICI-ILD. Three patients underwent ICI rechallenge, but two showed ICI-ILD recurrence and no patient achieved response to rechallenge treatment. Conclusion The DAD pattern may predict short-term adverse prognosis for ICI-ILD. Once ICI-ILD is overcome, severity grade is not associated with prognosis. Even if initial immunotherapy proves effective, ICI rechallenge requires careful consideration.