Clinical types of checkpoint inhibitor-related pneumonitis in lung cancer patients: a multicenter experience

Abstract

Background: Checkpoint inhibitor-related pneumonitis (CIP) is not well classified according to clinical factors. We propose different clinical sub-types of CIP based on clinical factors and investigated the corresponding clinical features, treatments, and outcomes. Methods:We conducted a multicenter retrospective study of patients with lung cancer (including nonsmall cell lung cancer and small cell lung cancer) who developed CIP. The clinical characteristics, radiologic features, treatments, and outcomes of CIP were analyzed.Results: A total of 55 patients developed CIP and were classified into 3 groups as follows: 21 in the pure type (PT) group, 14 in the induced type (IT) group, and 20 in the mixed type (MT) group. The incidence of severe (grade 3-5) pneumonitis was significantly higher in the IT group than in the PT and MT groups (71.4% vs. 14.3% vs. 50.0%, P=0.002). Antiviral therapy was significantly more frequent in the IT group than in the PT and MT groups. Antibiotic therapy was administered in 23.8%, 71.4%, and 80.0% of patients with the PT, IT, and MT, respectively. The improvement time in the PT group was longer than that in the IT and MT groups (0.9 vs. 0.5 vs. 0.3 months, P=0.028). Patients with the PT had a better tumor response to immune checkpoint inhibitors (ICIs) than those with the other 2 types [overall response rate (ORR), 78% vs. 31% vs. 44%, P=0.027]. Conclusions:The clinical classification of CIP may favor strategies for treatments and predict the tumor response to ICIs.

Proposed clinical phases for the improvement of personalized treatment of checkpoint inhibitor–related pneumonitis

“…The current treatment of CIP involves glucocorticoid therapy supplemented by immunosuppressive agents (such as infliximab and mycophenolate mofetil) and other supportive therapies as needed (9)(10)(11)(12)(13). Moreover, according to clinical experience and investigation, we recently proposed new clinical types of CIP, including the pure type, induced type, and mixed type, which may provide more individual management strategies for patients with CIP (14).…”

International consensus on severe lung cancer—the first edition

“…The incidence of CIP was found to be 3-5% in clinical studies and 7-13% in real-world studies (60), with a casefatality rate of 12.8-22.7% (61)(62)(63). The severity of CIP is positively correlated with the PS score (64).…”

Immune checkpoint inhibitor-related pneumonitis in non-small cell lung cancer: A review

“…The severity of these conditions is graded as follows: DAD>NSIP/HP>OP. In terms of incidence rate, OP has the highest incidence (65%), NSIP has a lower incidence (15%) and HP and DAD have the lowest incidence (10%) ( 55 , 56 ). The radiological features of cryptogenic organising pneumonitis (COP) may be a sign of enhanced efficacy of ICIs ( 57 ).…”