Saowapa Sakditad, Polpichai Natchaya, Siladech Pharit, Wannaphut Chalothorn, Tanariyakul Manasawee, Wattanachayakul Phuuwadith, Lalitnithi Pakin
Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.
Internal Medicine, Weiss Memorial Hospital, Chicago, USA.
Cureus. 2024 Jul 1;16(7):e63615. doi: 10.7759/cureus.63615. eCollection 2024 Jul.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, often diagnosed at the advanced stage (metastatic). Treatment options for metastatic NSCLC include radiotherapy, chemotherapy, target drug therapy, and immunotherapy. Immunotherapy (utilization of checkpoint inhibitors) boosts the immune system to recognize and destroy cancer cells. However, it is often associated with immune-related complications such as pneumonitis. This review aims to determine the incidence of pneumonitis in metastatic NSCLC patients treated with different immunotherapy drugs. PubMed, Cochrane Library, and Embase databases were scoured for randomized controlled trials (RCTs) until October 2023. Published RCTs with similar research objectives were included, while non-English articles, reviews, case reports, ongoing trials, non-randomized studies, conference abstracts, and studies on small cell lung cancer (SCLC) were excluded. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the risk of bias among the included studies. The statistical analyses were performed with the Comprehensive Meta-Analysis software. The subgroup analysis of the 16 included RCTs showed that metastatic NSCLC patients treated with nivolumab and pembrolizumab had a higher incidence of any grade pneumonitis than those treated with atezolizumab (4.5% and 5.1% vs. 1.6%, respectively). Similarly, the incidence of grade ≥3 pneumonitis was higher among patients receiving nivolumab (1.3%) and pembrolizumab (2.4%) than those receiving atezolizumab (0.7%). Furthermore, the subgroup analysis showed that patients with naive-treated NSCLC on immunotherapy had a higher incidence of any grade pneumonitis than those with previously treated NSCLC (6.5% vs. 3.9%). Treatment-naive patients recorded higher grade ≥3 pneumonitis incidences than those previously treated (3.1% vs. 1.3%). Programmed death 1 (PD-1) inhibitors (i.e., pembrolizumab and nivolumab) have higher incidences of pneumonitis than programmed death-ligand 1 inhibitors (atezolizumab).
非小细胞肺癌（NSCLC）是最常见的肺癌类型，通常在晚期（转移性）被诊断出来。转移性NSCLC的治疗选择包括放射治疗、化学治疗、靶向药物治疗和免疫治疗。免疫治疗（使用检查点抑制剂）可增强免疫系统以识别和破坏癌细胞。然而，它通常与免疫相关并发症如肺炎有关。本综述旨在确定接受不同免疫治疗药物治疗的转移性NSCLC患者中肺炎的发生率。检索了PubMed、Cochrane图书馆和Embase数据库，查找截至2023年10月的随机对照试验（RCT）。纳入了具有相似研究目标的已发表RCT，而排除了非英文文章、综述、病例报告、正在进行的试验、非随机研究、会议摘要以及关于小细胞肺癌（SCLC）的研究。使用随机试验的Cochrane偏倚风险工具（RoB 2）评估纳入研究中的偏倚风险。使用综合Meta分析软件进行统计分析。对纳入的16项RCT的亚组分析表明，接受纳武利尤单抗和帕博利珠单抗治疗的转移性NSCLC患者发生任何级别的肺炎的发生率高于接受阿替利珠单抗治疗的患者（分别为4.5%和5.1%对1.6%）。同样，接受纳武利尤单抗（1.3%）和帕博利珠单抗（2.4%）治疗的患者中≥3级肺炎的发生率高于接受阿替利珠单抗治疗的患者（0.7%）。此外，亚组分析表明，初治的NSCLC患者接受免疫治疗时发生任何级别的肺炎的发生率高于既往接受过治疗的NSCLC患者（6.5%对3.9%）。初治患者记录的≥3级肺炎发生率高于既往接受过治疗的患者（3.1%对1.3%）。程序性死亡1（PD-1）抑制剂（即帕博利珠单抗和纳武利尤单抗）引起肺炎的发生率高于程序性死亡配体1抑制剂（阿替利珠单抗）。
