Nakahama Kenji, Tamiya Akihiro, Isa Shun-Ichi, Taniguchi Yoshihiko, Shiroyama Takayuki, Suzuki Hidekazu, Inoue Takako, Tamiya Motohiro, Hirashima Tomonori, Imamura Fumio, Atagi Shinji
Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan.
In Vivo. 2018 Jul-Aug;32(4):887-891. doi: 10.21873/invivo.11324.
Compared to conventional cytotoxic chemotherapy, immune checkpoint inhibitors have shown a significant efficacy in the treatment of lung cancer. Although interstitial lung disease (ILD) is an important adverse event in immunotherapy, risk factors for ILD remain unclear.
In this multicenter cohort study (UMIN000025908), 201 patients who were treated with nivolumab were retrospectively reviewed. Associations between the incidence of ILD and patient characteristics were evaluated. ILD grade and progression-free survival were analyzed according to the presence or absence of imaging findings of airway obstruction adjacent to lung tumors (IAOT).
In the multivariate analysis, the odds ratio (OR) of ILD for patients with a history of radiation pneumonitis or IAOT was 3.96 (p=0.012) and 6.59 (p=0.004), respectively. ILD occurred in six (37.5%) out of 16 patients with IAOT and 19 (10.3%) out of 185 patients without IAOT. Three out of the six patients with ILD and IAOT had ILD of grade 4 or more. The median progression-free survival of patients with and without IAOT was 0.9 and 3.2 months, respectively (p<0.001).
IAOT was strongly associated with the occurrence of ILD after therapy with nivolumab.
与传统细胞毒性化疗相比，免疫检查点抑制剂在肺癌治疗中已显示出显著疗效。尽管间质性肺疾病（ILD）是免疫治疗中的一种重要不良事件，但其危险因素仍不清楚。
在这项多中心队列研究（UMIN000025908）中，对201例接受纳武单抗治疗的患者进行了回顾性分析。评估了ILD发生率与患者特征之间的关联。根据肺肿瘤邻近气道阻塞的影像学表现（IAOT）的有无，分析了ILD分级和无进展生存期。
在多变量分析中，有放射性肺炎病史或IAOT的患者发生ILD的比值比（OR）分别为3.96（p = 0.012）和6.59（p = 0.004）。16例有IAOT的患者中有6例（37.5%）发生ILD，185例无IAOT的患者中有19例（10.3%）发生ILD。6例有ILD和IAOT的患者中有3例ILD分级为4级或更高。有和无IAOT的患者的中位无进展生存期分别为0.9个月和3.2个月（p<0.001）。
IAOT与纳武单抗治疗后ILD的发生密切相关。
