Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
Department of Chemotherapy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
Respir Res. 2024 Jan 10;25(1):25. doi: 10.1186/s12931-024-02683-8.
Drug-induced interstitial lung disease (DIILD) is a serious adverse event potentially induced by any antineoplastic agent. Whether cancer patients are predisposed to a higher risk of DIILD after receiving immune checkpoint inhibitors (ICIs) is unknown.
This study retrospectively assessed the cumulative incidence of DIILD in consecutive cancer patients who received post-ICI antineoplastic treatment within 6 months from the final dose of ICIs. There was also a separate control cohort of 55 ICI-naïve patients with non-small cell lung cancer (NSCLC) who received docetaxel.
Of 552 patients who received ICIs, 186 met the inclusion criteria. The cohort predominantly comprised patients with cancer of the lung, kidney/urinary tract, or gastrointestinal tract. The cumulative incidence of DIILD in the entire cohort at 3 and 6 months was 4.9% (95% confidence interval [CI] 2.4%-8.7%) and 7.2% (95% CI 4.0%-11.5%), respectively. There were significant differences according to cancer type (Gray's test, P = .04), with the highest cumulative incidence of DIILD in patients with lung cancer being 9.8% (95% CI 4.3%-18.0%) at 3 months and 14.2% (95% CI 7.3%-23.3%) at 6 months. DIILD was caused by docetaxel in six of these 11 lung cancer patients (54.5%). After matching, the cumulative incidence of docetaxel-induced ILD in patients with NSCLC in the post-ICI setting was higher than that in the ICI-naïve setting: 13.0% (95% CI 3.3%-29.7%) vs 4.3% (95% CI 0.3%-18.2%) at 3 months; and 21.7% (95% CI 7.9%-39.9%) vs 4.3% (95% CI 0.3%-18.2%) at 6 months. However, these were not significant differences (hazard ratio, 5.37; 95% CI 0.64-45.33; Fine-Gray P = .12).
Patients with lung cancer were at high risk of developing DIILD in subsequent regimens after ICI treatment. Whether NSCLC patients are predisposed to additional risk of docetaxel-induced ILD by prior ICIs warrants further study.
药物性间质性肺病（DIILD）是一种严重的不良反应，可能由任何抗肿瘤药物引起。癌症患者在接受免疫检查点抑制剂（ICI）后是否更容易发生 DIILD 尚不清楚。
本研究回顾性评估了在最后一剂 ICI 后 6 个月内接受 ICI 后抗肿瘤治疗的连续癌症患者中 DIILD 的累积发生率。另有一个单独的对照组为 55 例非小细胞肺癌（NSCLC）患者，接受多西他赛治疗。
在 552 例接受 ICI 治疗的患者中，有 186 例符合纳入标准。该队列主要由肺癌、肾/泌尿道或胃肠道癌症患者组成。整个队列在 3 个月和 6 个月时 DIILD 的累积发生率分别为 4.9%（95%置信区间 [CI] 2.4%-8.7%）和 7.2%（95% CI 4.0%-11.5%）。根据癌症类型存在显著差异（Gray 检验，P=0.04），肺癌患者的 DIILD 累积发生率最高，3 个月时为 9.8%（95% CI 4.3%-18.0%），6 个月时为 14.2%（95% CI 7.3%-23.3%）。在这 11 例肺癌患者中，有 6 例（54.5%）是由多西他赛引起的 DIILD。匹配后，ICI 后 NSCLC 患者多西他赛诱导的 ILD 的累积发生率高于 ICI 初治患者：3 个月时为 13.0%（95% CI 3.3%-29.7%）和 4.3%（95% CI 0.3%-18.2%）；6 个月时为 21.7%（95% CI 7.9%-39.9%）和 4.3%（95% CI 0.3%-18.2%）。然而，这些差异没有统计学意义（风险比，5.37；95% CI 0.64-45.33；Fine-Gray P=0.12）。
肺癌患者在 ICI 治疗后后续治疗方案中发生 DIILD 的风险较高。NSCLC 患者是否因先前的 ICI 而增加多西他赛诱导的 ILD 的风险需要进一步研究。
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