Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.
Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore.
Int J Cancer. 2022 Feb 15;150(4):636-644. doi: 10.1002/ijc.33822. Epub 2021 Oct 13.
Immune-related adverse events (IrAEs) of immune checkpoint inhibitors (ICIs) can be serious and unpredictable. We examine the incidence rate and risk factors for IrAEs in an Asian cohort of nonsmall cell lung cancer (NSCLC) patients treated with immunotherapy. Between June 2014 and August 2020, we retrospectively analysed IrAEs in NSCLC patients treated with anti-PD-1 or anti-PD-L1 inhibitors at the National University Cancer Institute, Singapore. A Poisson regression model was used to estimate the effect of risk factors on incidence rate of any grade IrAEs. One hundred and forty-one patients were enrolled. Median age was 63. Majority were male (67%) with Eastern Cooperative Oncology Group (ECOG) PS 0-1 (77%). More than half (56%) received pembrolizumab. Eleven percent harboured epidermal growth factor receptor (EGFR) mutation. Eighteen percent received concomitant chemotherapy. Median number of cycles was 4, and median duration of treatment was 2.1 months. IrAEs were seen in 71 (50.4%) patients, with an incidence rate of 99 events per 1000 person-months. Fatigue (25%), rash (10.5%) and pneumonitis (7.9%) were the most common IrAEs. Twenty out of 152 IrAEs (13.2%) were Grade 3 or higher in severity: most common being pneumonitis (5.3%), fatigue (3.3%) and transaminitis (1.3%). Multivariable analysis demonstrated that concomitant chemotherapy use, higher BMI and presence of EGFR mutation are significant predictors for IrAEs (P < .0001; P = .016; P = .007). Our findings can help guide risk stratification and monitoring of IrAEs among NSCLC patients on immunotherapy.
免疫检查点抑制剂（ICI）相关的不良反应（IrAEs）可能是严重且不可预测的。我们研究了在接受免疫治疗的亚洲非小细胞肺癌（NSCLC）患者队列中，ICI 相关不良反应的发生率和危险因素。在 2014 年 6 月至 2020 年 8 月期间，我们回顾性分析了在新加坡国立癌症研究所接受抗 PD-1 或抗 PD-L1 抑制剂治疗的 NSCLC 患者的 IrAEs。采用泊松回归模型估计危险因素对任何级别 IrAEs 发生率的影响。共纳入 141 例患者。中位年龄为 63 岁，大多数为男性（67%），东部肿瘤协作组（ECOG）表现状态（PS）0-1（77%）。超过一半（56%）接受了 pembrolizumab 治疗。11%的患者存在表皮生长因子受体（EGFR）突变。18%的患者接受了联合化疗。中位治疗周期数为 4 个，中位治疗时间为 2.1 个月。71 例（50.4%）患者出现 IrAEs，发生率为 99 例/1000 人-月。最常见的 IrAEs 是疲劳（25%）、皮疹（10.5%）和肺炎（7.9%）。152 例 IrAEs 中有 20 例（13.2%）为 3 级或更高级别，最常见的是肺炎（5.3%）、疲劳（3.3%）和肝转氨酶升高（1.3%）。多变量分析表明，联合化疗、较高的 BMI 和 EGFR 突变的存在是 IrAEs 的显著预测因素（P < .0001；P=0.016；P=0.007）。我们的研究结果可以帮助指导 NSCLC 患者免疫治疗中 IrAEs 的风险分层和监测。
