Risk of pneumonitis in cancer patients treated with immune checkpoint inhibitors: a meta-analysis

Ther Adv Respir Dis. 2016 Jun;10(3):183-93. doi: 10.1177/1753465816636557. Epub 2016 Mar 4.


Background: A meta-analysis of the risk of pneumonitis associated with the use of immune checkpoint inhibitors in cancer patients has been conducted.

Methods: Eligible publications included randomized trials of cancer patients on immune checkpoint inhibitors, describing events of all-grade and high-grade pneumonitis.

Results: After exclusion of noneligible citations, a total of 11 clinical trials were eligible for the meta-analysis. The odds ratio was 3.96 [95% confidence interval (CI): 2.02-7.79; p < 0.0001] for all-grade pneumonitis and 2.87 (95% CI: 0.90-9.20; p = 0.08) for high-grade pneumonitis. Moreover, the odds ratio of all-grade pneumonitis with a nivolumab/ipilimumab combination versus ipilimumab monotherapy was 3.68 (95% CI: 1.59-8.50; p = 0.002) and, for high-grade pneumonitis, it was 1.86(95% CI: 0.36-9.53; p = 0.46). Subgroup analysis did not reveal a difference between lung cancer patients and other cancer patients in the risk of pneumonitis.

Conclusions: Our analysis provided evidence that the use of immune checkpoint inhibitors is associated with an increased risk of all-grade pneumonitis compared with chemotherapy or placebo controls.

Keywords: NSCLC; ipilimumab; nivolumab; pembrolizumab; pneumonitis.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Antibodies, Monoclonal / administration & dosage
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / pharmacology
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology
  • Humans
  • Ipilimumab
  • Neoplasms / drug therapy*
  • Neoplasms / pathology
  • Nivolumab
  • Pneumonia / chemically induced*
  • Randomized Controlled Trials as Topic
  • Risk


  • Antibodies, Monoclonal
  • Antineoplastic Agents
  • Ipilimumab
  • Nivolumab