Subsequent systemic therapy for non-small cell lung cancer patients with immune checkpoint inhibitor-related interstitial lung disease.
Subsequent systemic therapy for non-small cell lung cancer patients with immune checkpoint inhibitor-related interstitial lung disease.
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DOI：
10.21037/tlcr-21-198
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发表时间：
2021-07
影响因子：
4
通讯作者：
Kikuchi T
中科院分区：
文献类型：
--
作者：
Sato Y;Watanabe S;Ota T;Kushiro K;Fujisaki T;Takahashi M;Ohtsubo A;Shoji S;Nozaki K;Ichikawa K;Hokari S;Kondo R;Hayashi M;Ishikawa H;Miyabayashi T;Abe T;Miura S;Tanaka H;Okajima M;Terada M;Ishida T;Iwashima A;Sato K;Yoshizawa H;Aoki N;Ohshima Y;Koya T;Kikuchi T
尽管免疫检查点抑制剂（ICI）对晚期非小细胞肺癌（NSCLC）有效，但ICI可能导致间质性肺病（ILD），导致治疗中止，有时是致命的。尽管ICI相关ILD的发生率很高，但患者的癌症治疗选择很少。本研究旨在评价伴有ICI相关ILD的NSCLC患者后续全身癌症治疗的安全性和疗效。我们回顾性评估了2016年1月至2017年10月期间在新泻肺癌治疗组参与机构接受程序性细胞死亡-1（PD-1）抑制剂作为一线至三线治疗的NSCLC患者。该分析包括231例患者，其中32例（14%）发生了ICI相关ILD。在这些患者中，16例（7%）接受了后续的全身性癌症治疗。全身性癌症治疗组的中位总生存期（OS）往往长于非全身性癌症治疗组[22.2个月（95% CI：1-NE）vs. 4.5个月（95% CI：1-NE）; P=0.067]。半数接受全身癌症治疗的患者中ICI相关ILD复发，复发性ICI相关ILD患者的中位OS往往较短[22.0个月（95% CI：1-NE）vs. 7.0个月（95% CI：1-NE）; P=0.3154]。根据目前的研究，全身性癌症治疗对ICI相关ILD患者有效;但是，由于ICI相关ILD复发的风险较高，ILD复发后的生存结局较差，因此其安全性尚不确定。
Although immune checkpoint inhibitors (ICIs) are effective for advanced non-small cell lung cancer (NSCLC), ICIs may cause interstitial lung disease (ILD), which results in treatment discontinuation and is sometimes fatal. Despite the high incidence of ICI-related ILD, there are few cancer treatment options for patients. This study aimed to evaluate the safety and efficacy of subsequent systemic cancer therapy in NSCLC patients with ICI-related ILD. We retrospectively assessed NSCLC patients who received programmed cell death-1 (PD-1) inhibitors as first- to third-line therapy at participating institutions of the Niigata Lung Cancer Treatment Group from January 2016 to October 2017. This analysis included 231 patients, 32 (14%) of whom developed ICI-related ILD. Of these patients, 16 (7%) received subsequent systemic cancer treatments. The median overall survival (OS) tended to be longer in the systemic cancer therapy group than in the no systemic cancer therapy group [22.2 months (95% CI: 1–NE) vs. 4.5 months (95% CI: 1–NE); P=0.067]. ICI-related ILD recurred in half of the patients who received systemic cancer therapy, and the median OS tended to be shorter in patients with recurrent ICI-related ILD [22.0 months (95% CI: 1–NE) vs. 7.0 months (95% CI: 1–NE); P=0.3154]. According to the current study, systemic cancer treatment is effective in patients with ICI-related ILD; however, its safety is uncertain because of the high risk of ICI-related ILD recurrence and poor survival outcome following ILD recurrence.