免疫检查点抑制剂相关肺炎在合并慢性阻塞性肺疾病的非小细胞肺癌患者中的临床转归和危险因素。

Clinical outcomes and risk factor of immune checkpoint inhibitors-related pneumonitis in non-small cell lung cancer patients with chronic obstructive pulmonary disease.

机构信息

Department of Respiratory Diseases, Thoracic Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

BMC Pulm Med. 2022 Dec 1;22(1):458. doi: 10.1186/s12890-022-02190-w.

OBJECTIVES

Chronic obstructive pulmonary disease (COPD) is the most common co-morbidity associated with non-small cell lung cancer (NSCLC) patients. Immune checkpoint inhibitors related pneumonitis (CIP) is a common immune-related adverse event that can be life-threatening. The study aims to evaluate the association of COPD with the incidence and outcome of CIP in NSCLC patients receiving immune checkpoint inhibitors (ICIs).

MATERIALS AND METHODS

We retrospectively collected data from 122 patients diagnosed with NSCLC and treated with ICIs in our department. Baseline pulmonary function was performed in the whole cohort. The incidence, risk factors, treatment and outcome of CIP patients were evaluated. Furthermore, the efficacy of ICIs in patients with COPD was analyzed.

RESULTS

Nineteen patients (15.5%, 19/122) developed CIP during ICIs treatment, most patients with CIP were grade 1-2, and the incidence of CIP was comparable in patients with COPD and those without COPD (18.0% vs. 13.1%, P = 0.618). In addition, an increasing trend in the incidence of CIP among patients with pulmonary fibrosis on baseline chest CT scans (27.3% vs. 13.0%, P = 0.093). There is a longer progression-free survival in COPD patients than the non-COPD patients.

CONCLUSION

Coexisting COPD did not predict the higher risk of CIP in NSCLC treated with ICIs therapy. Nevertheless, pre-existing pulmonary fibrosis on CT scan may increase the risk of CIP, close monitoring is advised in these patients during ICIs.

目的

慢性阻塞性肺疾病（COPD）是与非小细胞肺癌（NSCLC）患者最常见的合并症。免疫检查点抑制剂相关的肺炎（CIP）是一种常见的免疫相关不良事件，可能危及生命。本研究旨在评估 COPD 与 NSCLC 患者接受免疫检查点抑制剂（ICIs）治疗时 CIP 发生率和结局的关系。

材料与方法

我们回顾性收集了在我科接受 ICI 治疗的 122 例 NSCLC 患者的数据。对所有患者进行了基线肺功能检查。评估了 CIP 患者的发生率、危险因素、治疗和结局。此外，还分析了 COPD 患者对 ICI 的疗效。

结果

19 例（15.5%，19/122）患者在 ICI 治疗期间发生 CIP，大多数 CIP 患者为 1-2 级，COPD 患者和非 COPD 患者的 CIP 发生率相当（18.0%比 13.1%，P=0.618）。此外，基线胸部 CT 扫描有肺纤维化的患者 CIP 发生率呈上升趋势（27.3%比 13.0%，P=0.093）。COPD 患者的无进展生存期长于非 COPD 患者。