Radiographic features and prognosis of early- and late-onset non-small cell lung cancer immune checkpoint inhibitor-related pneumonitis

Abstract

Background Immunotherapy is becoming a standard of care for non-small cell lung cancer (NSCLC). Checkpoint inhibitor-associated pneumonia (CIP) is a rare and potentially life-threatening event that can occur at any time during tumor immunotherapy. However, there may be differences in the radiological patterns and prognosis of CIP during different periods. This study aimed to investigate the radiographic features and prognosis of early- and late-onset immune-related pneumonitis. Methods We retrospectively analyzed the clinical data of 677 NSCLC patients receiving immunotherapy to identify 32 patients with CIP, analyzed the clinical and radiographic data, and summarized the radiological features and prognosis of early- and late-onset CIP. Results CIP had an incidence of 4.7%, a median onset time of 10 weeks, and a mortality of 28.1%. Among these, CIP included 14 early-onset cases, where grade ≥ 3 CIP accounted for 92.9%, main radiographic pattern was organizing pneumonia (OP)-like pattern, and mortality was 50.0%. We also identified 18 late-onset CIPs, where grade ≥ 3 CIP accounted for 50.0%, main radiographic pattern was nonspecific interstitial pneumonia (NSIP)-like pattern, and mortality was 11.1%. The overall survival rate of the early-onset group was significantly lower than that of the late-onset group (P < 0.05). Conclusion Early-onset CIP cases were higher in the Common Terminology Criteria for Adverse Events (CTCAE v5.0) grade and mainly presented with an OP-like radiographic pattern; whereas, late-onset CIP cases were lower in CTCAE grade and mainly presented with an NSIP-like radiographic pattern. Finally, the prognosis of the early-onset CIP group was poorer than that of the late-onset CIP group. We believe that this study will be helpful for clinicians for making early diagnosis and deciding treatment modalities for patients with CIP.

Advances in CT features and radiomics of checkpoint inhibitor-related pneumonitis: A short review

“…instead analyzed in a larger sample size (64 cases) and found COP to be the most common pattern (15/64, 23.4%), followed by HP (10/64, 15.6%), NSIP and bronchiectasis in 7.8% (5/64) and 6.3% (4/64), respectively and another 23 with unspecified pneumonia (35.9%) ( 12 ). Subsequent published studies consistently found the COP pattern as the most common type in both lung and non-lung tumors ( 13 – 15 ). There was no significant difference in imaging patterns between early-onset and late-onset CIP ( 15 ).…”

“…Subsequent published studies consistently found the COP pattern as the most common type in both lung and non-lung tumors ( 13 – 15 ). There was no significant difference in imaging patterns between early-onset and late-onset CIP ( 15 ). The AIP/ARDS type turned out to have the highest adverse effect grade, while NSIP and HP seemed to be mild (median grade: 3, 2, 1, 1; p = 0.006) ( 13 ).…”

The CURB65 score predicted 180-day mortality of non-small cell lung carcinoma patients with immune checkpoint inhibitor-associated pneumonitis: A pilot retrospective analysis

“…However, all published studies about CIP in lung cancer had a relatively small sample size, and most studies were case reports or case series. A study by Atchley et al included 30 lung cancer patients with CIP, and another study by Huang et al recruited 32 NSCLC patients with CIP ( 23 , 24 ). Our sample size was comparable to the previous studies.…”

Chinese expert consensus on the multidisciplinary management of pneumonitis associated with immune checkpoint inhibitor

“… 51 Patients with early‐onset of CIP, within 6 weeks of ICI treatment, often have severe symptoms and poor prognosis, whereas patients with late‐onset of CIP, after 6 weeks of ICI treatment, often have few symptoms and better prognosis. 52 …”