Impact of Checkpoint Inhibitor Pneumonitis on Survival in Non-Small Cell Lung Cancer Patients receiving Immune Checkpoint Immunotherapy
(1) Suresh K (2) Psoter KJ (3) Voong KR (4) Shankar B (5) Forde PM (6) Ettinger DS (7) Marrone KA (8) Kelly RJ (9) Hann CL (10) Levy B (11) Feliciano JL (12) Brahmer JR (13) Feller-Kopman D (14) Lerner AD (15) Lee H (16) Yarmus L (17) Hales RK (18) D'Alessio F (19) Danoff SK (20) Naidoo J
(1) Suresh K (2) Psoter KJ (3) Voong KR (4) Shankar B (5) Forde PM (6) Ettinger DS (7) Marrone KA (8) Kelly RJ (9) Hann CL (10) Levy B (11) Feliciano JL (12) Brahmer JR (13) Feller-Kopman D (14) Lerner AD (15) Lee H (16) Yarmus L (17) Hales RK (18) D'Alessio F (19) Danoff SK (20) Naidoo J
With increasing use of immune checkpoint inhibitors (ICI) for advanced non-small cell lung cancer (NSCLC), there is increasing recognition of immune related adverse events (irAEs) associated with ICI use. We recently reported increased incidence of checkpoint inhibitor pneumonitis (CIP) in ICI-treated NSCLC patients. Since development of irAEs in other organ systems has been associated with either no change or even improvement in tumor response/cancer outcomes, we sought to better understand the impact of CIP development on overall survival in ICI-treated NSCLC patients. Using baseline and follow-up data collected on a cohort of 205 ICI-treated NSCLC patients, we employed a multi-state modeling approach to understand the effect of developing CIP on the risk of death. We observed time-dependent changes in risk of developing and recovery from CIP, with an increased risk of both developing and recovering from CIP in the first year after initiating ICI. Interestingly, we found that developing CIP independently increased the risk of transitioning to death in both adjusted and unadjusted models. In the multi-variate model, we found that the increase in mortality associated with CIP was only seen in patients with adenocarcinoma tumor histology. Collectively, these findings suggest that in NSCLC, development of CIP worsens survival in patients receiving immunotherapy.
Author Info:
(1) Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine. Electronic address: ksuresh2@jhmi.edu. (2) Department of Pediatrics, Johns Hopkins Un
iversity School of Medicine. (3) Department of Radiation Oncology, Johns Hopkins University School of Medicine. (4) Department of Oncology, Johns Hopkins University School of Medicine. (5) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. (6) Department of Oncology, Johns Hopkins University School of Medicine. (7) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. (8) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. (9) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. (10) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. (11) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. (12) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. (13) Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine. (14) Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine. (15) Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine. (16) Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine. (17) Department of Radiation Oncology, Johns Hopkins University School of Medicine. (18) Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine. (19) Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine. (20) Department of Oncology, Johns Hopkins University School of Medicine; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University.
Citation: J Thorac Oncol 2018 Nov 29 Epub11/29/2018
