Toxicities of Immunotherapy for Small Cell Lung Cancer

Fu, Yang Xin; Zheng, Yue; Wang, Peipei; Ding, Zhenyu

doi:10.3389/fonc.2021.603658

Cited by 9 publications

(7 citation statements)

References 43 publications

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“…Recently, developments in lung cancer patients with advanced stages of the disease have shown immunotherapy as a promising treatment option. However, the expanded use of ICIs has resulted in noticeable growth in adverse events, particularly irAEs ( 6 , 68 ). With more treatment options with ICIs now approved for advanced lung cancer, a robust analysis is urgently required to compare the risk of safety profiles among all of the different treatment regimens.…”

Section: Discussionmentioning

confidence: 99%

A Network Comparison on Safety Profiling of Immune Checkpoint Inhibitors in Advanced Lung Cancer

Yan

Cui

et al. 2021

Front. Immunol.

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BackgroundImmune checkpoint inhibitors (ICIs) have become one of the standard treatment options for advanced lung cancer. However, adverse events (AEs), particularly immune–related AEs (irAEs), caused by these drugs have aroused public attention. The current network meta-analysis (NMA) aimed to compare the risk of AEs across different ICI–based regimens in patients with advanced lung cancer.MethodsWe systematically searched the PubMed, EMBASE, and Cochrane Library databases (from inception to 19 April 2021) for relevant randomized controlled trials (RCTs) that compared two or more treatments, with at least one ICI administered to patients with advanced lung cancer. The primary outcomes were treatment–related AEs and irAEs, including grade 1–5 and grade 3–5. The secondary outcomes were grade 1–5 and grade 3–5 irAEs in specific organs. Both pairwise and network meta-analyses were conducted for chemotherapy, ICI monotherapy, ICI monotherapy + chemotherapy, dual ICIs therapy, and dual ICIs + chemotherapy for all safety outcomes. Node–splitting analyses were performed to test inconsistencies in network. Sensitivity analyses were adopted by restricting phase III RCTs and studies that enrolled patients with non–small cell lung cancer.ResultsOverall, 38 RCTs involving 22,178 patients with advanced lung cancer were enrolled. Both pooled incidence and NMA indicated that treatments containing chemotherapy increased the risk of treatment–related AEs when compared with ICI-based regimens without chemotherapy. As for grade 1–5 irAEs, dual ICIs + chemotherapy was associated with the highest risk of irAEs (probability in ranking first: 50.5%), followed by dual-ICI therapy (probability in ranking second: 47.2%), ICI monotherapy (probability in ranking third: 80.0%), ICI monotherapy + chemotherapy (probability in ranking fourth: 98.0%), and finally chemotherapy (probability in ranking fifth: 100.0%). In grade 3–5 irAEs, subtle differences were observed; when ranked from least safe to safest, the trend was dual ICIs therapy (60.4%), dual ICIs + chemotherapy (42.5%), ICI monotherapy (76.3%), ICI monotherapy + chemotherapy (95.0%), and chemotherapy (100.0%). Furthermore, detailed comparisons between ICI–based options provided irAE profiles based on specific organ/system and severity.ConclusionsIn consideration of overall immune–related safety profiles, ICI monotherapy + chemotherapy might be a better choice among ICI–based treatments for advanced lung cancer. The safety profiles of ICI–based treatments are various by specific irAEs and their severity.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42021268650

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Section: Discussionmentioning

confidence: 99%

A Network Comparison on Safety Profiling of Immune Checkpoint Inhibitors in Advanced Lung Cancer

Yan

Cui

et al. 2021

Front. Immunol.

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“…While immunotherapy brings survival benefits to ES-SCLC patients, it is inevitably accompanied by various IRAEs, which may result in treatment interruption and even more serious harm. 36,37 Therefore, it is important to search for potential indicators that can predict IRAEs. However, no reliable predictor of IRAEs in SCLC has been identified so far.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Nutritional Index Predicts Efficacy and Immune-Related Adverse Events of First-Line Chemoimmunotherapy in Patients with Extensive-Stage Small-Cell Lung Cancer

Zhang,

Chen,

et al. 2024

JIR

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Background: Currently, there is a lack of well-established markers to predict the efficacy of chemoimmunotherapy in small-cell lung cancer (SCLC). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), advanced lung cancer inflammation index (ALI) and prognostic nutritional index (PNI) are associated with prognosis in several tumors, whereas their predictive role in SCLC remains unclear. Methods: A retrospective study was conducted at Sun Yat-sen University Cancer Center, involving extensive-stage SCLC (ES-SCLC) patients who received first-line chemoimmunotherapy between January 2020 and December 2021. Peripheral blood biomarkers were extracted from medical records and their correlation with prognosis and immune-related adverse events (IRAEs) was analyzed. Results: A total of 114 patients were included. Patients with a low PLR, high ALI and high PNI had prolonged progression-free survival (PFS) compared to those with a high PLR, low ALI and low PNI. Patients with a low NLR, low PLR, high ALI and high PNI had prolonged overall survival (OS) compared to those with a high NLR, high PLR, low ALI and low PNI. Cox regression model showed that PNI was an independent risk factor for both PFS and OS. ROC curve showed that PNI outperforms NLR, PLR and ALI in predicting both PFS and OS. The PNI-based nomogram demonstrated strong predictive capability for both PFS and OS. In addition, there was a significant correlation between PNI and IRAEs. Conclusion: A high baseline PNI might be associated with improved prognosis and the occurrence of IRAEs in ES-SCLC patients treated with first-line chemoimmunotherapy.

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“…11 In small cell lung cancer (SCLC) patients, the incidence of immune-related adverse events (irAEs) such as pneumonitis caused by PD-L1 inhibitors is lower than that of PD-1 (4.3% vs. 2.1%). 12 Previous study showed that the incidence of CIP in Japanese patients (8%-14%) is higher than that in non-Asian population. 13 To date, the different incidence of CIP among Asian and non-Asian patient remains unclear.…”

Section: Introductionmentioning

confidence: 96%

“…A meta‐analysis showed that programmed cell death protein‐1(PD‐1) inhibitors had a higher risk of CIP than programmed death ligand‐1 (PD‐L1) inhibitors 11 . In small cell lung cancer (SCLC) patients, the incidence of immune‐related adverse events (irAEs) such as pneumonitis caused by PD‐L1 inhibitors is lower than that of PD‐1 (4.3% vs. 2.1%) 12 …”

Section: Introductionmentioning

confidence: 99%

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

Wang

et al. 2022

Thoracic Cancer

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Immune checkpoint inhibitors (ICIs) have successfully treated a number of different types of cancer, which is of great significance for cancer treatment. With the widespread use of ICIs in clinical practice, the increasing checkpoint inhibitor pneumonia (CIP) will be a challenge to clinicians. To guide the diagnosis and treatment of CIP, we conducted in-depth discussions based on the latest evidence, forming a consensus among Chinese experts on the multidisciplinary management of CIP. K E Y W O R D S checkpoint inhibitor pneumonitis, Chinese experts consensus, immune checkpoint inhibitor-related adverse effectsWenxian Wang, Qian Wang and Chunwei Xu, contributed equally to this study.

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Toxicities of Immunotherapy for Small Cell Lung Cancer

Cited by 9 publications

References 43 publications

A Network Comparison on Safety Profiling of Immune Checkpoint Inhibitors in Advanced Lung Cancer

A Network Comparison on Safety Profiling of Immune Checkpoint Inhibitors in Advanced Lung Cancer

Prognostic Nutritional Index Predicts Efficacy and Immune-Related Adverse Events of First-Line Chemoimmunotherapy in Patients with Extensive-Stage Small-Cell Lung Cancer

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

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