Risk factors for acute exacerbation in lung cancer complicated by interstitial lung disease with slight reticular shadows

Takahara, Yutaka; Tanaka, Takuya; Ishige, Yoko; Shionoya, Ikuyo; Yamamura, Koichi; Sakuma, Takashi; Nishiki, Kazuaki; Nakase, Keisuke; Nojiri, Masafumi; Kato, Ryo; Shinomiya, Shohei; Fujimoto, Yuki; Oikawa, Taku; Mizuno, Shiro

doi:10.1111/1759-7714.14121

Cited by 4 publications

(7 citation statements)

References 26 publications

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“…In total, 319 records were screened and 300 articles were excluded based on their titles and abstracts. All investigators fully assessed the remaining 19 articles and agreed to include 17 eligible studies comprising 5,529 patients in the subsequent meta-analysis (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Search Resultsmentioning

confidence: 99%

“…Second, the pooled grade 3-5 ICIP rate was 12% (95% CI: 9-15%) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)28). No statistically significant heterogeneity was obtained (I 2 =0.0%, P=0.64) and there was little variation among the studies (Figure 2B).…”

Section: The Pooled Icip Rate In Nsclc Patients With Pre-existing Ildmentioning

confidence: 92%

“…Of the six studies, only nivolumab was administered in five studies (12)(13)(14)23,26), and atezolizumab in one study (19). In the remaining nine studies, ICIs such as nivolumab, pembrolizumab, atezolizumab, and durvalumab were administered in various treatment lines (15)(16)(17)(20)(21)(22)24,27,28).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The pooled any-grade and grade 3-5 ICIP rates were obtained from 17 and 16 eligible studies, respectively (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The pooled any-grade ICIP rate was 30% [95% confidence interval (CI): 24-36%] (12-28) and statistically significant heterogeneity was obtained through analysis (I 2 =53.7%, P=0.01) (Figure 2A).…”

Section: The Pooled Icip Rate In Nsclc Patients With Pre-existing Ildmentioning

confidence: 99%

“…Although the safety and efficacy have been evaluated in a few prospective observational studies with a small number of cases and multiple retrospective observational studies (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), there is no consensus regarding the use of ICIs in NSCLC patients with pre-existing ILD. Thus, we performed a meta-analysis using the available reports to elucidate the risks and benefits of ICIs for advanced NSCLC patients with pre-existing ILD.…”

Section: Introductionmentioning

confidence: 99%

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Impact of treatment line on risks and benefits of immune checkpoint inhibitor in patients with advanced non-small cell lung cancer and interstitial lung disease: a systematic review and meta-analysis of cohort studies

Matsumoto¹,

Shiroyama²,

Kuge³

et al. 2022

Transl Lung Cancer Res

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Background: There is no clear consensus regarding the safety and efficacy of immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC) and pre-existing interstitial lung disease (ILD). We aimed to elucidate the impact of ICIs on pre-existing ILD. Methods:We systematically queried PubMed-MEDLINE, Embase-Scopus, and ISI Web of Science databases up to January 10, 2022. The pooled any-grade and grade 3-5 ICI-associated pneumonitis (ICIP) rate and objective response rate (ORR) in patients with pre-existing ILD were mainly evaluated. The relative risk (RR) was also evaluated for pre-existing ILD and usual interstitial pneumonia (UIP) patterns. Sensitivity and subgroup analyses were performed to assess the heterogeneity.Results: In total, 17 studies involving 5,529 patients were included in the meta-analysis. The pooled ICIP rate was 30% [95% confidence interval (CI): 24-36%]; it was found to be significantly higher in patients with pre-existing ILD relative to those without (RR = 3.05, 95% CI: 2.53-3.69; I2=0.0%). The pooled grade 3-5 ICIP rate was 12% (95% CI: 9-15%); this was also significantly higher in patients with pre-existing ILD (RR =3.19, 95% CI: 2.32-4.38; I2=0.0%). According to subgroup analysis, these ICIP rates were not significantly different among the treatment lines (first, ≥ second, and mixed) (P=0.33) whereas the pooled ORR was 36% (95% CI: 24-48%; I2=53.7%) with a significant difference among the treatment lines (P=0.027). The pooled ICIP rate was independent of the UIP pattern (RR =1.06, 95% CI: 0.86-1.32; I2=0.0%).Discussion: Overall, ICIs should be administered cautiously in patients with pre-existing ILD, regardless of the treatment line. Moreover, the risks of ICIP may outweigh ICI benefits, especially in second-or laterline treatment. These results need to be further confirmed by meta-analyses including more observational cohort studies in clinical setting.

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Section: Search Resultsmentioning

confidence: 99%

Section: The Pooled Icip Rate In Nsclc Patients With Pre-existing Ildmentioning

confidence: 92%

Section: Study Characteristicsmentioning

confidence: 99%

Section: The Pooled Icip Rate In Nsclc Patients With Pre-existing Ildmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of treatment line on risks and benefits of immune checkpoint inhibitor in patients with advanced non-small cell lung cancer and interstitial lung disease: a systematic review and meta-analysis of cohort studies

Matsumoto¹,

Shiroyama²,

Kuge³

et al. 2022

Transl Lung Cancer Res

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Are Immune Checkpoint Inhibitors Safe and Effective in Lung Cancer Patients with Pre-Existing Interstitial Lung Disease?

Zhu,

Gao,

et al. 2024

Immunotherapy

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Aim: This study aims to clarify the efficacy and adverse effects of immune checkpoint inhibitors (ICIs) in the lung cancer patients with a history of interstitial lung disease (ILD). Methods: From the inception of the database to 4 April 2023, we systematically searched the four databases. Results: The objective remission rate, disease control rate, incidence of immune-associated pneumonitis (ICIP) in the combined ILD group were significantly higher than those in the non-combined ILD group. There were no significant differences between the two groups in progression-free survival, overall survival, renal insufficiency, thyroid dysfunction and gastrointestinal toxicity. Conclusion: Generally, a pre-existing ILD history can increase the efficacy and incidence of ICIs' adverse reactions. Therefore, ICIs should be administered with caution.

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Safety and Efficacy of Single-Fraction Carbon-Ion Radiotherapy for Early-Stage Lung Cancer with Interstitial Pneumonia

Aoki,

Ishikawa,

Nakajima

et al. 2024

Cancers

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Patients with lung cancer complicated by interstitial pneumonia (IP) often lose treatment options early owing to acute exacerbation of IP concerns. Carbon-ion radiotherapy (CIRT) can provide superior tumor control and low toxicity at high dose concentrations. We conducted a retrospective analysis of the efficacy and tolerability of a single-fraction CIRT using 50 Gy for IP-complicated lung cancer. The study included 50 consecutive patients treated between April 2013 and September 2022, whose clinical stage of lung cancer (UICC 7th edition) was 1A:1B:2A:2B = 32:13:4:1. Of these, 32 (64%) showed usual interstitial pneumonia patterns. With a median follow-up of 23.5 months, the 3-year overall survival (OS), cause-specific survival, and local control rates were 45.0, 75.4, and 77.8%, respectively. The median lung V5 and V20 were 10.0 and 5.2%, respectively (mean lung dose, 2.6 Gy). The lung dose, especially lung V20, showed a strong association with OS (p = 0.0012). Grade ≥ 2 pneumonia was present in six patients (13%), including two (4%) with suspected grade 5. CIRT can provide a relatively safe and curative treatment for patients with IP-complicated lung cancer. However, IP increases the risk of severe radiation pneumonitis, and further studies are required to assess the appropriate indications.

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Risk factors for acute exacerbation in lung cancer complicated by interstitial lung disease with slight reticular shadows

Cited by 4 publications

References 26 publications

Impact of treatment line on risks and benefits of immune checkpoint inhibitor in patients with advanced non-small cell lung cancer and interstitial lung disease: a systematic review and meta-analysis of cohort studies

Impact of treatment line on risks and benefits of immune checkpoint inhibitor in patients with advanced non-small cell lung cancer and interstitial lung disease: a systematic review and meta-analysis of cohort studies

Are Immune Checkpoint Inhibitors Safe and Effective in Lung Cancer Patients with Pre-Existing Interstitial Lung Disease?

Safety and Efficacy of Single-Fraction Carbon-Ion Radiotherapy for Early-Stage Lung Cancer with Interstitial Pneumonia

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