Safety and Efficacy of Immune Checkpoint Inhibitors in Cancer Patients and Preexisting Autoimmune Disease: A Systematic Review and Meta-Analysis in Non–Small-Cell Lung Cancer

Aung, Wint Yan; Lee, Chung-Shien; Morales, Jaclyn; Rahman, Husneara; Seetharamu, Nagashree

doi:10.1016/j.cllc.2023.05.006

Cited by 7 publications

(1 citation statement)

References 42 publications

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“…The relationship between underlying autoimmunity and pneumonitis has not been well-established. Aung et al conducted a systematic review examining the safety and efficacy of ICI in patients with preexisting autoimmune disease and NSCLC, for which they reported a higher risk of grade 3 and 4 irAE in this population in pooled analysis [28]. Our results further support the careful selection of the patient population when offering durvalumab, balancing benefit versus risk for patients that may be at higher risk of developing a potentially life-threatening irAE such as pneumonitis.…”

Section: Discussionsupporting

confidence: 69%

Durvalumab-Associated Pneumonitis in Patients with Locally Advanced Non-Small Cell Lung Cancer: A Real-World Population Study

Lim,

Ghosh,

Morrison

et al. 2023

Current Oncology

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The PACIFIC trial led to a new standard of care for patients with locally advanced lung cancer, but real-world practice has demonstrated that immune checkpoint inhibitor (ICI) pneumonitis can lead to significant clinical complications. This study aimed to examine the clinical predictors, outcomes, and healthcare utilization data in patients who received consolidation durvalumab. Using the Alberta Immunotherapy Database, NSCLC patients who received durvalumab in Alberta, Canada, from January 2018 to December 2021 were retrospectively evaluated. We examined incidence and predictive values of severe pneumonitis, with overall survival (OS) and time-to-treatment failure (TTF) using exploratory multivariate analyses. Of 189 patients, 91% were ECOG 0–1 and 85% had a partial response from chemoradiation prior to durvalumab. Median TTF and OS were not reached; 1-year OS was 82%. An amount of 26% developed any grade of pneumonitis; 9% had ≥grade 3 pneumonitis. Male gender and a pre-existing autoimmune condition were associated with severe pneumonitis. V20 was associated with any grade of pneumonitis. Pneumonitis development was found to be an independent risk factor for worse OS (p = 0.038) and TTF (p = 0.007). Our results suggest clinical and dosimetric predictive factors of durvalumab-associated pneumonitis. These results affirm the importance of careful patient selection for safe completion of consolidation durvalumab in real-world LA-NSCLC population.

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Section: Discussionsupporting

confidence: 69%