Impact of immune-related adverse events on clinical outcomes in patients with advanced non-small cell lung cancer with low PD-L1 expression, focusing on pneumonitis: a multicenter retrospective study in Japan.

IF 4 2区医学 Q2 ONCOLOGY

Translational lung cancer research Pub Date : 2025-04-30 Epub Date: 2025-04-17 DOI:10.21037/tlcr-2024-1177

Shiho Goda, Tadaaki Yamada, Kenji Morimoto, Tae Hata, Yasuhiro Goto, Akihiko Amano, Yoshiki Negi, Satoshi Watanabe, Naoki Furuya, Tomohiro Oba, Tatsuki Ikoma, Akira Nakao, Keiko Tanimura, Hirokazu Taniguchi, Akihiro Yoshimura, Tomoya Fukui, Daiki Murata, Kyoichi Kaira, Shinsuke Shiotsu, Asuka Okada, Makoto Hibino, Yusuke Chihara, Takashi Kijima, Koichi Takayama

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引用次数: 0

Abstract

Background: Severe immune-related adverse events (irAEs) are often associated with combined immunotherapy and chemotherapy in patients with non-small cell lung cancer (NSCLC). However, their effect on clinical outcomes has yet to be fully elucidated. In this study, we investigated the impact of irAEs, particularly pneumonitis, on clinical outcomes in patients receiving combined immunotherapy and chemotherapy for NSCLC.

Methods: We retrospectively enrolled 850 patients with programmed cell death ligand-1 (PD-L1) 1-49% advanced NSCLC who were treated with chemotherapy alone or with combined immunotherapy and chemotherapy as first-line treatment at 19 different institutions in Japan between March 2017 and June 2022. Using data from their medical records, we examined the type and severity of irAEs and their association with clinical outcomes, including overall survival (OS) and progression-free survival (PFS).

Results: OS and PFS were not significantly different between patients with and without severe irAEs. However, in the group receiving combined immunotherapy and chemotherapy, those who developed pneumonitis within 42 days of treatment initiation had shorter OS and PFS, irrespective of the pneumonitis grade, and a worse prognosis than those who received chemotherapy alone. Additionally, early-onset pneumonitis was more likely in patients aged >75 years, those with high lactate dehydrogenase levels, and those receiving steroids or immunosuppressants, suggesting that these factors may contribute to the risk of early-onset pneumonitis.

Conclusions: Early-onset pneumonitis is a poor prognostic factor in patients with PD-L1 1-49% advanced NSCLC receiving combined immunotherapy and chemotherapy. Further large-scale observational studies are warranted to confirm these findings.

Keywords: Non-small cell lung cancer (NSCLC); severe immune-related adverse events (irAEs); pneumonitis.

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免疫相关不良事件对低PD-L1表达的晚期非小细胞肺癌患者临床结局的影响，重点是肺炎：日本的一项多中心回顾性研究

背景：严重的免疫相关不良事件（irAEs）通常与非小细胞肺癌（NSCLC）患者的联合免疫治疗和化疗有关。然而，它们对临床结果的影响尚未完全阐明。在这项研究中，我们调查了irAEs，特别是肺炎，对接受联合免疫治疗和化疗的非小细胞肺癌患者的临床结果的影响。方法：我们回顾性招募了850例程序性细胞死亡配体-1 (PD-L1) 1-49%的晚期NSCLC患者，这些患者在2017年3月至2022年6月期间在日本19个不同的机构接受了单独化疗或联合免疫治疗和化疗作为一线治疗。使用他们的医疗记录数据，我们检查了irae的类型和严重程度及其与临床结果的关系，包括总生存期（OS）和无进展生存期（PFS）。结果：严重irAEs患者的OS和PFS无显著差异。然而，在接受联合免疫治疗和化疗的组中，那些在治疗开始后42天内发生肺炎的患者，无论肺炎的级别如何，其OS和PFS都较短，预后比单独接受化疗的患者更差。此外，早发性肺炎更可能发生在bb0 ~ 75岁、乳酸脱氢酶水平高、接受类固醇或免疫抑制剂治疗的患者中，这表明这些因素可能会增加早发性肺炎的风险。结论：在接受联合免疫治疗和化疗的PD-L1 1-49%晚期非小细胞肺癌患者中，早发性肺炎是一个不良预后因素。需要进一步的大规模观察研究来证实这些发现。关键词：非小细胞肺癌；严重免疫相关不良事件（irAEs）；肺炎。

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来源期刊

Translational lung cancer research Medicine-Oncology

CiteScore

7.20

自引率

2.50%

发文量

137

期刊介绍： Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.