The utility of ground-glass attenuation score for anticancer treatment-related acute exacerbation of interstitial lung disease among lung cancer patients with interstitial lung disease

Nakatani, Naoki; Honda, Takayuki; Sema, Manabu; Kawahara, Teruhiko; Jin, Yasuto; Natsume, Ichiro; Chiaki, Tomoshige; Yamashita, T.; Tsukada, Yoshikazu; Taki, Reiko; Miyashita, Yoshihiro; Saito, Kazuhito; Tateishi, Tomoya; Sakashita, Hiroyuki; Miyazaki, Yasunari

doi:10.1007/s10147-019-01576-x

Cited by 24 publications

(21 citation statements)

References 45 publications

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“…In the sensitivity analyses excluding the crude ORs, 10 studies were included [25][26][27][28][29][30][31][32][33][34]. Risk factors that could be pooled and were significantly related with the development of irAEs were squamous histology (OR 1.847; CI 95% 1.048-3.256), a higher number of pack-years of smoked tobacco (OR 2.662; CI 95% 1.014-6.989) and the presence of ground glass attenuation in CT imaging (OR 77.1; CI 95% 7.82-760.3) (Supplementary Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…of studies No. of participants Abnormal CT findings (abnormal CT vs normal CT) 1.193 0.607 2.343 1.04 0.307 4.20% 0.609 2 [ 29 ] [ 48 ] 253 Age (≥ 65 vs < 65) 1.124 0.904 1.396 11.43 0.178 30% 0.292 10 [ 25 ] [ 26 ] [ 27 ] [ 28 ] [ 31 ] [ 33 ] [ 45 ] [ 47 ] [ 53 ] [ 55 ] 2442 Age (years) 0.988 0.954 1.023 0.39 0.533 0.00% 0.49 2 [ 29 ] [ 48 ] 253 Asthma (history of asthma vs no history of asthma) 1.729 0.226 13.209 0.87 0.35 0.00% 0.598 2 [ 26 ] [ 56 ] 305 Black ethnicity (black vs white ethnicity) 0.709 0.346 1.456 1.42 0.233 …”

Section: Resultsmentioning

confidence: 99%

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Risk factors for adverse events induced by immune checkpoint inhibitors in patients with non-small-cell lung cancer: a systematic review and meta-analysis

Suazo-Zepeda

Bokern

Vinke

et al. 2021

Cancer Immunol Immunother

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Background Immune checkpoint inhibitors (ICIs) can cause serious immune-related adverse events (irAEs). This study aimed to identify risk factors for all types of irAEs induced by ICIs in patients with non-small-cell lung cancer (NSCLC), by systematic review and meta-analyses. Methods A systematic search was performed in Pubmed, Embase and Web of Science by two independent reviewers. Studies were selected that included patients with NSCLC and evaluated characteristics of patients with and without irAEs induced by ICIs. Quality and risk of bias of the selected studies were assessed. Random effects meta-analyses were conducted to estimate pooled odds ratios (ORs) for risk factors of developing all type of irAEs, and separately for pneumonitis, interstitial lung disease and severe irAEs. With the objective of exploring sources of heterogeneity, stratified analyses were performed by quality and region. Results 25 studies met the inclusion criteria. In total, the data of 6696 patients were pooled. 33 different risk factors for irAEs were reported. irAEs of interest were reported for 1653 (25%) of the patients. Risk factors related to the development of irAEs were: C-reactive protein, neutrophil lymphocyte ratio (NLR), use of PD-1 inhibitor, high PD-L1 expression, an active or former smoking status, ground glass attenuation, and a better treatment response. Conclusion The identified risk factors for the development of these irAEs are mostly related to the alteration of the immune system, proinflammatory states and loss of immunological self-tolerance. Patients identified as having a higher risk for irAEs should be monitored more closely.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk factors for adverse events induced by immune checkpoint inhibitors in patients with non-small-cell lung cancer: a systematic review and meta-analysis

Suazo-Zepeda

Bokern

Vinke

et al. 2021

Cancer Immunol Immunother

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“…Therefore, the effect of the existing ILD subtypes other than IPF was not investigated. As GGOs were reported to be an independent risk factor for ICI-ILD in previous reports, 25,26 it is possible that there are populations with high AE risk among the ILDs classified as alternative diagnosis. To clarify the risk of AEs due to ICI in lung cancer complicated by ILDs, a large-scale study including ILD patients with GGO-dominant imaging patterns will be necessary.…”

Section: Discussionmentioning

confidence: 92%

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

et al. 2021

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Background The risk of cancer treatment‐related acute exacerbation (AE) in patients with lung cancer and mild interstitial lung disease (ILD) on imaging, classified as indeterminate for usual interstitial pneumonia (UIP), has not previously been clarified. Methods We retrospectively reviewed the clinical records of 27 patients with lung cancer and ILD who were diagnosed and treated from April 2016 to March 2021. Results Among the 27 patients, 21 were classified as indeterminate for UIP and six as UIP/probable UIP; furthermore, 10 (46.6%) and three (50%) patients from each group, respectively, developed treatment‐related AEs. No significant difference was observed regarding the incidence of AEs between the two groups. However, significantly more patients in the AE group received immune checkpoint inhibitors (ICIs) compared to the non‐AE group (p = 0.021). Multivariate analysis revealed that the use of ICIs was a significant independent risk factor for treatment‐related AEs. Conclusions Lung cancer patients with mild ILD suggestive of indeterminate for UIP and UIP patterns are at an increased risk for treatment‐related AEs. Furthermore, ICI use is an independent risk factor for AEs in patients with lung cancer complicated by ILD, and ICIs should be used with great caution.

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“…25 In terms of other pulmonary diseases, smoking is a risk factor in idiopathic pulmonary brosis, 26,27 but there is currently a lack of clarity on the involvement of smoking and coexisting emphysema in acute exacerbation events. [28][29][30][31] Concerning radiation pneumonitis, the existing data on smoking and comorbid emphysema as risk factors are not consistent. [32][33][34][35] Conversely, interstitial pneumonia was correlated with symptomatic or all pneumonitis in this study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for pneumonitis in advanced extrapulmonary cancer patients treated with immune checkpoint inhibitors

Uchida

Kinose

Nagatani

et al. 2021

Preprint

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Background Immune-mediated pneumonitis has a high mortality rate; however, little is known about the related risk factors. We analyzed the risk factors for pneumonitis, such as smoking and lung metastasis (LM), among extrapulmonary primary tumors. Methods We retrospectively collected data of 110 patients treated with immune checkpoint inhibitors (ICIs) (nivolumab/pembrolizumab) for extrapulmonary primary tumors at the Shiga University of Medical Science Hospital, between January 2015 and December 2019. The frequency of pneumonitis was evaluated based on the time between the start of ICI treatment and the onset of symptomatic or all pneumonitis. The severity of pneumonitis was graded according to the Common Terminology Criteria for Adverse Events, version 5.0. We analyzed the risk factors, such as the absence or presence of interstitial lung disease (ILD) and lung metastases (LMs), or other clinical factors, including smoking status before ICI administration. Results The Cox proportional hazards regression analysis revealed that the smoking index and presence of ILD were significant factors for an increased rate of all pneumonitis (hazard ratio [HR] = 20.3, 95% confidence interval [CI] = 20.0–20.4; p = 0.02 and HR = 4.3, 95% CI = 1.2–12.1; p = 0.03, respectively). LM was significantly related to an increased rate of symptomatic pneumonitis (HR = 6.8, 95% CI = 1.3–124.2; p = 0.02). Conclusions Smoking index and ILD were the significant risk factors for ICI-induced pneumonitis. LM was a significant risk factor for ICI-induced symptomatic pneumonitis. Therefore, pre-screening for ILD and LM and the recognition of patients’ smoking histories are important for determining the risk of ICI-induced pneumonitis and allowing safe ICI administration.

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The utility of ground-glass attenuation score for anticancer treatment-related acute exacerbation of interstitial lung disease among lung cancer patients with interstitial lung disease

Cited by 24 publications

References 45 publications

Risk factors for adverse events induced by immune checkpoint inhibitors in patients with non-small-cell lung cancer: a systematic review and meta-analysis

Risk factors for adverse events induced by immune checkpoint inhibitors in patients with non-small-cell lung cancer: a systematic review and meta-analysis

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

Risk factors for pneumonitis in advanced extrapulmonary cancer patients treated with immune checkpoint inhibitors

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