PD-1/PD-L1 inhibitor treatment and its impact on clinical imaging in non-small cell lung cancer: a systematic review and meta-analysis of immune-related adverse events

Nader Mohammed; En-Hua Xiao; Shallal Mohsen; Zeng Xiong; RongRong Zhou

doi:10.3389/fonc.2023.1191681

PD-1/PD-L1 inhibitor treatment and its impact on clinical imaging in non-small cell lung cancer: a systematic review and meta-analysis of immune-related adverse events

Front Oncol. 2023 Sep 29:13:1191681. doi: 10.3389/fonc.2023.1191681. eCollection 2023.

Authors

Nader Mohammed¹, En-Hua Xiao¹, Shallal Mohsen², Zeng Xiong^{3

4}, RongRong Zhou^{3

5

6}

Affiliations

¹ Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
² Diagnostic Radiology Department, Cairo University, Cairo, Egypt.
³ Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁴ Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁵ Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁶ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.

Abstract

Background: In the contemporary era of cancer treatment, lung cancer (LC) holds the unenviable position of being the primary contributor to cancer-induced mortality worldwide. Although immunotherapy has expanded the therapeutic landscape for metastatic non-small cell lung cancer (NSCLC), the advent of immune checkpoint inhibitors has been accompanied by a concomitant increase in immune-related adverse events (irAEs). Timely detection of irAEs is pivotal for efficacious management and enhanced patient outcomes. Diagnostic imaging, encompassing x-ray and CT scans, can facilitate the identification and supervision of irAEs, thereby ensuring the prompt recognition of associated patterns and alterations for expeditious treatment.

Methods: The present inquiry undertook a systematic exploration of multiple databases, incorporating a diverse array of studies such as randomized controlled trials and observational analyses. Patient demographics, imaging outcomes, and risk of bias were extracted from the data. Meta-analysis was executed utilizing R Statistical Software, with the results of the risk of bias assessment summarized accordingly.

Findings: The analysis unveiled a higher prevalence of irAEs in patients receiving first-line treatment for NSCLC compared to those receiving subsequent treatments, with a statistically significant distinction observed for both high- and low-grade irAEs (p < 0.001). Pneumonitis, thyroiditis, and colitis emerged as the most frequently reported irAEs, whereas hepatitis and pancolitis were less commonly documented. This investigation signifies a crucial advancement in elucidating the function of imaging in the treatment of NSCLC with PD-1/PD-L1 inhibitors and emphasizes the imperative for ongoing research in this domain.

Keywords: PD1/PDL1inhibitor; adverse events; imaging; lung cancer; non-small cell.

Publication types

Systematic Review

Grants and funding

This work was supported by National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Building Project for Major Diseases (Lung Cancer, grant number: z027002).