Dosimetric Risk Factors for Acute Radiation Pneumonitis in Patients With Prior Receipt of Immune Checkpoint Inhibitors

Bi, Jianping; Qian, Jing; Yang, Dongqin; Sun, Lu; Lin, Shitong; Liu, Ying; Xue, Xudong; Tang, Nujiang; Verma, Vivek; Hân, Gia

doi:10.3389/fimmu.2021.828858

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…It is convinced that the synergistic effect of TRT and ICI is strong, careful consideration and close monitoring of pneumonitis are needed for patients with previous treatment-related pneumonitis evoked by either TRT or ICI. However, we did not observe high incidence of pneumonitis among patients with antecedent ICI before TRT, while a small-size, single-arm retrospective study showed a relative high rate of G3+ RP (22.5%) in patients with prior ICI ( 32 ). Dosimetric variables were also not associated with G2+ or G3+ treatment-related pneumonitis in this study.…”

Section: Discussioncontrasting

confidence: 80%

Comprehensive Pneumonitis Profile of Thoracic Radiotherapy Followed by Immune Checkpoint Inhibitor and Risk Factors for Radiation Recall Pneumonitis in Lung Cancer

Wang

Zhang

et al. 2022

Front. Immunol.

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PurposeWhilst survival benefits of thoracic radiotherapy (TRT) followed by immune checkpoint inhibitor (ICI) have been reported in patients with lung cancer, the potential high risk of treatment-related pneumonitis remains a concern. Asians may be more sensitive to lung toxicity than other races. This retrospective study intended to provide a comprehensive pneumonitis profile of TRT followed by ICI and investigate the risk factors from a Chinese cohort of lung cancer.Methods and MaterialsFrom January 2016 to July 2021, 196 patients with lung cancer who received TRT prior to ICI were retrospectively analyzed. Treatment-related pneumonitis, including checkpoint inhibitor pneumonitis (CIP), radiation pneumonitis (RP), and radiation recall pneumonitis (RRP), were recorded and graded through medical records and chest computed tomography. Characteristics predictive of pneumonitis were assessed using logistic regression models, and the receiver operating characteristic analyses were performed to identify optimal cut points for quantitative variables.ResultsWith a median follow-up of 18 months, a total of 108 patients (55.1%) developed treatment-related pneumonitis during ICI therapy, with an incidence of 25.5% for grade 2 or higher (G2+) and 4.1% for G3+. The overall rates of CIP, RP and RRP were 8.2% (n=16), 46.9% (n=92) and 7.1% (n=14), respectively. With a total mortality rate of 1.5%, vast majority of the patients recovered from pneumonitis or remained stable. No patients died of RRP. Half of the patients with G2+ RP who withheld ICI therapy restarted ICI safely after resolution of RP. The history of chronic pulmonary diseases (P=0.05), mean lung dose (MLD, P=0.038), percent volume of lung receiving ≥5 Gy (V5, P=0.012) and percent volume of lung receiving ≥20 Gy (V20, P=0.030) predicted the occurrence of RRP in univariate analyses. Interval between TRT and ICI less than 3 months was an independent predictor for G2+ treatment-related pneumonitis in a multivariate model (Odds ratio OR=2.787, P=0.004).ConclusionsTreatment-related pneumonitis, especially RRP, is acceptable and manageable in the setting of TRT followed by ICI in this Asian population. Dosimetric parameters MLD, V5 and V20 may improve the predictions of RRP in clinical practice.

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Section: Discussioncontrasting

confidence: 80%

Comprehensive Pneumonitis Profile of Thoracic Radiotherapy Followed by Immune Checkpoint Inhibitor and Risk Factors for Radiation Recall Pneumonitis in Lung Cancer

Wang

Zhang

et al. 2022

Front. Immunol.

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“…Chemotherapy, as a signi cant risk factor for predicting radiation pneumonitis, is consistent with the results of this study [16].There is still controversy regarding the correlation between dosimetric parameters and the occurrence of radiation pneumonitis. The study by Jianping Bi et al concluded that the mean lung dose (MLD) is the most critical dose-volume parameter in uencing radiation pneumonitis, and it can better prevent the occurrence of radiation pneumonitis in patients undergoing combined immunotherapy and radiotherapy [20].On the other hand, Zhe Ji et al…”

Section: Discussionmentioning

confidence: 99%

Constructing a nomogram model for close-range radiotherapy using radioactive 125I particles to treat radiation-induced pneumonia in advanced lung cancer

Ding,

Hao,

Wang

et al. 2024

Preprint

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Purpose: The most common and potentially fatal side effect of postoperative close-range radiotherapy using radioactive 125I particles in the chest is radiation-induced pneumonia (RP). This study aims to develop a dynamic nomogram to accurately predict radiation-induced pneumonia in lung cancer patients following close-range radiotherapy with radioactive 125I particles. Methods: A retrospective analysis was conducted on data from 436 advanced lung cancer patients who underwent close-range radiotherapy using radioactive 125I particles at the Northern Theater General Hospital of the Chinese People's Liberation Army from January 2016 to December 2023. Risk factors for radiation-induced pneumonia were identified through LASSO logistic regression and multivariable logistic regression analysis, which were then used to construct a dynamic nomogram. The predictive performance of the nomogram was validated using ROC curves, calibration plots, and decision curve analysis (DCA). Lastly, the grading of radiation-induced pneumonia and Kaplan-Meier analysis were performed. Results: Preoperative N and M staging, maximum dose, and whether chemotherapy was administered were identified as important factors for accurately predicting radiation-induced pneumonia. A dynamic nomogram for radiation-induced pneumonia was developed using these risk factors. The area under the ROC curve was 0.878 (95% CI 0.814-0.942) for the training cohort and 0.828 (95% CI 0.787-0.870) for the validation cohort. The nomogram demonstrated good calibration. The maximum dose parameter in both the training and validation cohorts achieved the most ideal clinical benefits, showing promising clinical utility. Patients staged as T1 and T3 preoperatively were more likely to develop radiation-induced pneumonia compared to those staged as T2 (P<0.001). Patients staged as M1 preoperatively, those receiving a maximum dose above the mean, and those who had received chemotherapy had a higher probability of developing radiation-induced pneumonia (P<0.001). Conclusion: The developed dynamic nomogram provides a precise and convenient tool for clinical application to predict the risk of radiation-induced pneumonia in lung cancer patients undergoing close-range radiotherapy with radioactive 125I particles.

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“…Most of them reported the recalled RP in patients receiving ICI after cCRT ( 21 , 23 , 24 ). Bi et al reported pneumonitis in patients receiving ICI before radiation ( 22 ). The RP of grade ≥2 was present in 40% (16/40) patients, and that of grade ≥3 was 22.5% (9/40), but it also did not compare to the chemoradiation group.…”

Section: Discussionmentioning

confidence: 99%

Real-world incidence and risk factors of pneumonitis in chemoradiation plus immune checkpoint inhibitors compared with chemoradiation alone in lung cancer: a retrospective cohort study

Pu,

Liu,

Zhang

et al. 2024

Transl Lung Cancer Res

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Background Immune checkpoint inhibitors (ICIs) have shown high efficacy in lung cancer. Adding ICIs to chemoradiation might increase the treatment efficacy, while the application of ICIs or chemoradiation alone can induce treatment-related pneumonitis, so whether combination therapy would increase the risk of pneumonitis needs careful evaluation. This study aimed to retrospectively analyze the incidence of pneumonitis in patients who underwent chemoradiation combined with ICIs compared with chemoradiation alone and explore the risk factors of pneumonitis in combination therapy. Methods This was a retrospective cohort study. Patients who received conventional thoracic radiation with a minimum total dose of 50 Gy for lung cancer between January 2020 and December 2021 at West China Hospital were retrospectively reviewed and followed up for at least 6 months after radiation. Patients were divided into two groups according to whether chemoradiation was administered with or without ICIs. Pneumonitis was evaluated by chest computed tomography (CT) at least every 2 months in outpatient department. The clinical characteristics, including sex, age, smoking history, pathological diagnosis, baseline pulmonary disease [including chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD)], treatment strategy, location of primary tumor and radiological dosimetric parameters were recorded. Chi-squared tests or Fisher’s exact tests were performed to analyze the difference between the combination group and control group for categorical variables and Mann-Whitney U test for continuous variables. Univariate and multivariate analyses were performed by logistic regression. Results A total of 152 patients who received chemoradiation were enrolled. The median age was 59 years. A total of 115 (75.7%) patients were non-small cell lung cancer (NSCLC), 22 (14.5%) were small cell lung cancer (SCLC), and 15 (9.9%) were other pathological types. Among them, 58 received chemoradiation combined with ICIs and 94 received chemoradiation alone. The rate of grade ≥2 pneumonitis was significantly higher in the combination therapy group (39.7% vs. 22.3%, P=0.028) and was associated with the use of ICIs [odds ratio (OR): 2.641, 95% confidence interval (CI): 1.244–5.608, P=0.011] and percent volume of the lung receiving ≥30 Gy (V30) (OR: 1.728, 95% CI: 1.214–2.460, P=0.002). The history of chronic lung disease was the independent risk factor (OR: 6.359, 95% CI: 1.953–20.705, P=0.002) of grade ≥3 pneumonitis. In the combination group, univariate and multivariate analyses revealed that V5, V20, V30, and mean lung dose (MLD) were not associated with pneumonitis, whereas the history of chronic lung disease was an independent risk factor of grade ≥3 pneumonitis (OR: 8.351, 95% CI: 1.469–47.484, P=0.017). Conclusions The incidence of pneumonitis of ICIs combined with chemoradiation...

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Dosimetric Risk Factors for Acute Radiation Pneumonitis in Patients With Prior Receipt of Immune Checkpoint Inhibitors

Cited by 9 publications

References 20 publications

Comprehensive Pneumonitis Profile of Thoracic Radiotherapy Followed by Immune Checkpoint Inhibitor and Risk Factors for Radiation Recall Pneumonitis in Lung Cancer

Comprehensive Pneumonitis Profile of Thoracic Radiotherapy Followed by Immune Checkpoint Inhibitor and Risk Factors for Radiation Recall Pneumonitis in Lung Cancer

Constructing a nomogram model for close-range radiotherapy using radioactive 125I particles to treat radiation-induced pneumonia in advanced lung cancer

Real-world incidence and risk factors of pneumonitis in chemoradiation plus immune checkpoint inhibitors compared with chemoradiation alone in lung cancer: a retrospective cohort study

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