Pre-existing pulmonary fibrosis is a risk factor for anti-PD-1-related pneumonitis in patients with non-small cell lung cancer: A retrospective analysis
Pre-existing pulmonary fibrosis is a risk factor for anti-PD-1-related pneumonitis in patients with non-small cell lung cancer: A retrospective analysis
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DOI：
10.1016/j.lungcan.2018.10.001
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发表时间：
2018-11-01
期刊：
影响因子：
5.3
通讯作者：
Hida, Toyoaki
中科院分区：
文献类型：
--
作者：
Yamaguchi, Teppei;Shimizu, Junichi;Hida, Toyoaki
目的：与使用抗程序性死亡 1 (PD-1) 抗体相关的肺炎是一种常见的免疫相关不良事件，可能危及生命。然而，肺纤维化/肺气肿与抗PD-1相关肺炎发病率之间的关系尚不清楚。 材料和方法：我们回顾性回顾了2015年12月17日至2015年12月17日期间在日本爱知县癌症中心医院诊断为非小细胞肺癌并接受抗PD-1抗体（nivolumab或pembrolizumab）治疗的123例患者的数据。 2017年11月30日。先前接受过原发灶、纵隔、脊柱或肋骨转移胸部放射治疗的患者被排除在分析之外。由两名诊断放射科医生确定基线胸部计算机断层扫描 (CT) 上的纤维化评分 (0-5) 和肺气肿评分 (0-4)。 结果：18 名患者 (14.6%) 经历了抗 PD-1 相关肺炎，其中 4 名 (3.3%) 为≥ 3 级。开始抗 PD-1 治疗后肺炎的中位发病时间为 60 天（范围为 6-634 天） 天）。根据纤维化评分分析，纤维化评分≥1的37例患者中有13例（35.1%）发生肺炎，纤维化评分为0的86例患者中有5例（5.8%）发生肺炎。单因素和多因素logistic回归分析显示，纤维化评分≥1是抗PD-1相关肺炎的唯一危险因素（p= 0.0008).结论：我们的结果 表明预先存在的肺纤维化显着增加抗 PD-1 相关肺炎的风险。需要进一步的研究来确定 CT 表现出现纤维化改变的患者抗 PD-1 相关肺炎的预测因素。
Objectives: Pneumonitis related to the use of anti-programmed death 1 (PD-1) antibodies is a common immune related adverse event that can be life-threatening. However, the relationship between pulmonary fibrosis/emphysema and the incidence of anti-PD-1-related pneumonitis is unclear.Materials and methods: We retrospectively reviewed data from 123 patients who were diagnosed with non-small- cell lung cancer and treated with anti-PD-1 antibodies (nivolumab or pembrolizumab) at the Aichi Cancer Center Hospital, Japan, between December 17, 2015, and November 30, 2017. Patients who previously received thoracic radiotherapy to the primary lesion, mediastinum, spinal, or rib metastases were excluded from the analysis. Fibrosis score (0-5) and emphysema score (0-4) on baseline chest computed tomography (CT) were determined by two diagnostic radiologists.Results: Eighteen patients (14.6%) experienced anti-PD-1-related pneumonitis, of which four (3.3%) were grade >= 3. The median onset time of pneumonitis after starting anti-PD-1 therapy was 60 days (range, 6-634 days). According to the analysis of fibrosis score, pneumonitis occurred in 13 (35.1%) of the 37 patients with a fibrosis score >= 1 and in 5 (5.8%) of 86 patients with a fibrosis score of 0. Univariate and multivariate logistic regression analysis revealed that fibrosis score >= 1 was the only risk factor for anti-PD-1-related pneumonitis (p = 0.0008).Conclusion: Our results indicate that pre-existing pulmonary fibrosis significantly increases the risk of anti-PD-1 related pneumonitis. Further studies are needed to identify predictive factors of anti-PD-1-related pneumonitis in patients with fibrotic changes on CT findings.