Safety of thoracic radiotherapy after PD‐(L)1 inhibitor treatment in patients with lung cancer

Chen, Yú; Liu, Xinchao; Huang, Zhaoqin; Zhao, Kaikai; Wang, Yao; Ren, Fei; Yu, Jinming; Meng, Xiangjiao

doi:10.1002/cam4.4363

Cited by 5 publications

(2 citation statements)

References 40 publications

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“…In clinical trials of ICIs after conventional TRT, the incidences of any grade pneumonia and grade ≥ 3 pneumonia were 13–33% and 1–9%, respectively, compared with 56–62% and 2% observed in the real world [ 11 ]. In a previous study from our group, we observed a significant increase in the incidence and severity of treatment-related pneumonia in patients who underwent TRT after ICIs (grade ≥ 2, 48.96%; grade ≥ 3, 19.79%), and fatal pneumonia occurred in 6.25% of patients [ 42 ]. As the primary end point of this study, we observed that the incidence of all grades, grade 2 or higher, and grade 3 or higher pneumonia in the TRT group was 35.1%, 24.6%, and 5.2%, respectively, which was higher than that in the non-TRT group; however, a majority of patients recovered from pneumonia or remained stable.…”

Section: Discussionmentioning

confidence: 93%

Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer

et al. 2023

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Background The CREST study showed that the addition of thoracic radiotherapy (TRT) could improve the survival rate in patients with extensive stage small cell lung cancer (ES-SCLC), but whether TRT can bring survival benefit in the era of immunotherapy remains controversial. This study aimed to explore the efficacy and safety of adding TRT to the combination of PD-L1 inhibitors and chemotherapy. Methods The patients who received durvalumab or atezolizumab combined with chemotherapy as the first-line treatment of ES-SCLC from January 2019 to December 2021 were enrolled. They were divided into two groups, based on whether they received TRT or not. Propensity score matching (PSM) with a 1:1 ratio was performed. The primary endpoints were progression-free survival (PFS), overall survival (OS) and safety. Results A total of 211 patients with ES-SCLC were enrolled, of whom 70 (33.2%) patients received standard therapy plus TRT as first-line treatment, and 141 (66.8%) patients in the control group received PD-L1 inhibitors plus chemotherapy. After PSM, a total of 57 pairs of patients were enrolled in the analysis. In all patients, the median PFS (mPFS) in the TRT and non-TRT group was 9.5 and 7.2 months, respectively, with HR = 0.59 (95%CI 0.39–0.88, p = 0.009). The median OS (mOS) in the TRT group was also significantly longer than that in the non-TRT group (24.1 months vs. 18.5 months, HR = 0.53, 95%CI 0.31–0.89, p = 0.016). Multivariable analysis showed that baseline liver metastasis and the number of metastases ≥ 3 were independent prognostic factors for OS. Addition of TRT increased the incidence of treatment-related pneumonia (p = 0.018), most of which were grade 1–2. Conclusions Addition of TRT to durvalumab or atezolizumab plus chemotherapy significantly improves survival in ES-SCLC. Although it may leads to increased incidence of treatment-related pneumonia, a majority of the cases can be relieved after symptomatic treatment.

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Section: Discussionmentioning

confidence: 93%

Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer

et al. 2023

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“…A recent retrospective study in patients who underwent TRT after ICI evaluated the incidence and severity of treatment-related pneumonitis. It showed that the incidence and severity of treatment-related pneumonitis was significantly higher in lung cancer patients who received TRT after ICI ( 13 ). As is known, acute “radiation pneumonitis” usually occurs within 4 to 12 weeks after thoracic irradiation.…”

Section: Discussionmentioning

confidence: 99%

Case report: Pneumonia with clinical symptoms precedes imaging evidence after immune checkpoint inhibitors combined with radiotherapy in lung squamous cell cancer

Wang

Wang²,

Yu³

et al. 2022

Front. Immunol.

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Immune-checkpoint inhibitors (ICI) targeting programmed cell death 1 (PD-1) and its ligand 1 (PD-L1) have quickly changed the treatment landscape in advanced non-small cell lung cancer. However, any patient treated with an immune checkpoint inhibitor is at risk for immune-related adverse events (irAEs). Checkpoint inhibitor pneumonitis (CIP) is a rare but potentially severe pulmonary toxicity of immunotherapy. Since the imaging features and symptoms are not specific, the diagnosis of CIP is challenging. In addition, CIP may mimic other lung diseases. Due to these characteristics, proper patient management may be delayed. So, a comprehensive understanding of imaging features is essential for a prompt detection and correct management of these drug-induced lung diseases. We presented a patient with lung squamous cell cancer who has clinical symptoms preceding imaging evidence of pneumonitis after immunotherapy and radiotherapy. We also discussed the safety of immunotherapy, the complexity and management of immune pneumonitis.

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