Clinical Characteristics and Management of Checkpoint Inhibitor Pneumonitis in Non-Small-Cell Lung Cancer Patients After Neoadjuvant Immunotherapy.

Abstract

Objective: Neoadjuvant immunotherapy with checkpoint inhibitors has shown promising results for non-small-cell lung cancer (NSCLC) patients. However, it has been associated with immune-related adverse events (irAEs), including checkpoint inhibitor pneumonitis (CIP), which can be life-threatening.

Methods: This retrospective study analysed the medical records of 197 NSCLC patients who underwent neoadjuvant checkpoint inhibitor therapy to investigate the incidence, clinical characteristics, and management of CIP.

Results: Of the 197 patients, 24 (12.2%) developed CIP. The majority of patients presented with respiratory symptoms, and ground-glass opacities were the most common radiographic finding. Patients with CIP had a longer duration of immunotherapy and a higher baseline C-reactive protein level than those without CIP. Most cases were mild to moderate in severity (Grade 1: 11, Grade 2: 6, Grade 3: 5) and managed with corticosteroids, while 2 patients of Grade 4 developed severe respiratory failure requiring mechanical ventilation. No patient died due to respiratory failure.

Conclusions: CIP was identified as a potential complication of neoadjuvant treatment with checkpoint inhibitors in patients with resectable NSCLC. Therefore, close monitoring for CIP and prompt recognition and management of symptoms are essential for the safe use of checkpoint inhibitors in NSCLC patients. While the study also found that such neoadjuvant treatment can induce a major pathological response in a significant proportion of these patients, further research is required to fully understand and manage the risk factors of CIP in this patient population.