Barrón Feliciano, Sánchez Roberto, Arroyo-Hernández Marisol, Blanco Carolina, Zatarain-Barrón Zyanya L, Catalán Rodrigo, Ramos-Ramírez Maritza, Cardona Andrés F, Flores-Estrada Diana, Arrieta Oscar
Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, Mexico.
Cancer Center, ABC Medical Center, México City, Mexico.
Front Oncol. 2020 Sep 29;10:570233. doi: 10.3389/fonc.2020.570233. eCollection 2020.
Immune checkpoint inhibitor-related pneumonitis (ICIP) is a potentially life threatening immune-related adverse event (irAE), especially in non-small cell lung cancer (NSCLC) patients. Currently, the potential for increased irAE in patients who receive radiotherapy is scarcely known, although a connection between antitumor immune responses and irAEs has been suggested. In this study, we evaluated the development of ICIP in non-small cell lung cancer patients with prior radiotherapy, treated with immunotherapy in the second-line.
In this retrospective trial, we included patients treated with second-line immunotherapy at the National Cancer Institute in Mexico City from February 2015 to February 2018. Clinical, radiological and treatment variables were evaluated according to the presence of ICIP as defined by the Common Terminology Criteria for Adverse Events (4.0) in patients with or without a previous (≥months) history of radiotherapy.
Among 101 NSCLC patients who received treatment with ICIs, 22 patients (21.8%) were diagnosed with ICIP, of which 73% (16/22) had a history of radiotherapy (OR 6.04, 95% CI 2.03-18.0, < 0.001). Median progression free survival and overall survival were similar in patients who developed ICIP compared with those who did not, however, patients who presented grade ≥ 2 ICIP had an increased risk of mortality (HR 2.54, 95% CI 1.20-5.34, = 0.014).
In this real-world cohort of NSCLC patients treated with ICI, the history of prior radiotherapy was associated with increased risk for ICIP development. Unlike other irAEs, grade ≥ 2 ICIP is an independent prognostic factor for decreased survival in NSCLC patients.
免疫检查点抑制剂相关肺炎（ICIP）是一种潜在的危及生命的免疫相关不良事件（irAE），尤其在非小细胞肺癌（NSCLC）患者中。目前，尽管已有研究表明抗肿瘤免疫反应与irAE之间存在关联，但接受放疗的患者发生irAE增加的可能性却鲜为人知。在本研究中，我们评估了接受过放疗的非小细胞肺癌患者在二线接受免疫治疗时ICIP的发生情况。
在这项回顾性试验中，我们纳入了2015年2月至2018年2月在墨西哥城国家癌症研究所接受二线免疫治疗的患者。根据不良事件通用术语标准（4.0）定义的ICIP情况，对有或无既往（≥数月）放疗史的患者的临床、放射学和治疗变量进行评估。
在101例接受免疫检查点抑制剂治疗的NSCLC患者中，22例（21.8%）被诊断为ICIP，其中73%（16/22）有放疗史（比值比6.04，95%置信区间2.03 - 18.0，P<0.001）。发生ICIP的患者与未发生ICIP的患者的无进展生存期和总生存期相似，然而，出现≥2级ICIP的患者死亡风险增加（风险比2.54，95%置信区间1.20 - 5.34，P = 0.014）。
在这个接受免疫检查点抑制剂治疗的NSCLC患者的真实世界队列中，既往放疗史与ICIP发生风险增加相关。与其他irAE不同，≥2级ICIP是NSCLC患者生存降低的独立预后因素。
