Clinical types of checkpoint inhibitor-related pneumonitis in lung cancer patients: a multicenter experience

Xinqing Lin; Haiyi Deng; Likun Chen; Di Wu; Xiaobo Chen; Yilin Yang; Tao Chen; Xiaohong Xie; Zhanhong Xie; Ming Liu; Ming Ouyang; Yinyin Qin; Shiyue Li; Nanshan Zhong; Jeffrey P Gregg; Nobuyuki Horita; Yong Song; Chengzhi Zhou

doi:10.21037/tlcr-20-1258

Clinical types of checkpoint inhibitor-related pneumonitis in lung cancer patients: a multicenter experience

Transl Lung Cancer Res. 2021 Jan;10(1):415-429. doi: 10.21037/tlcr-20-1258.

Authors

Xinqing Lin^{1

2}, Haiyi Deng¹, Likun Chen^{3

4

5}, Di Wu⁶, Xiaobo Chen¹, Yilin Yang¹, Tao Chen¹, Xiaohong Xie¹, Zhanhong Xie¹, Ming Liu¹, Ming Ouyang¹, Yinyin Qin¹, Shiyue Li¹, Nanshan Zhong¹, Jeffrey P Gregg⁷, Nobuyuki Horita⁸, Yong Song^{2

9}, Chengzhi Zhou¹

Affiliations

¹ State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
² The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
⁴ State Key Laboratory of Oncology in South China, Guangzhou, China.
⁵ Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
⁶ Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
⁷ Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA, USA.
⁸ Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
⁹ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China.

Abstract

Background: Checkpoint inhibitor-related pneumonitis (CIP) is not well classified according to clinical factors. We propose different clinical sub-types of CIP based on clinical factors and investigated the corresponding clinical features, treatments, and outcomes.

Methods: We conducted a multicenter retrospective study of patients with lung cancer (including non-small cell lung cancer and small cell lung cancer) who developed CIP. The clinical characteristics, radiologic features, treatments, and outcomes of CIP were analyzed.

Results: A total of 55 patients developed CIP and were classified into 3 groups as follows: 21 in the pure type (PT) group, 14 in the induced type (IT) group, and 20 in the mixed type (MT) group. The incidence of severe (grade 3-5) pneumonitis was significantly higher in the IT group than in the PT and MT groups (71.4% vs. 14.3% vs. 50.0%, P=0.002). Antiviral therapy was significantly more frequent in the IT group than in the PT and MT groups. Antibiotic therapy was administered in 23.8%, 71.4%, and 80.0% of patients with the PT, IT, and MT, respectively. The improvement time in the PT group was longer than that in the IT and MT groups (0.9 vs. 0.5 vs. 0.3 months, P=0.028). Patients with the PT had a better tumor response to immune checkpoint inhibitors (ICIs) than those with the other 2 types [overall response rate (ORR), 78% vs. 31% vs. 44%, P=0.027].

Conclusions: The clinical classification of CIP may favor strategies for treatments and predict the tumor response to ICIs.

Keywords: Immune checkpoint inhibitor (ICI); checkpoint inhibitor-related pneumonitis (CIP); immune-related adverse events; lung cancer, clinical types.