Pre-existing interstitial lung abnormalities are risk factors for immune checkpoint inhibitor-induced interstitial lung disease in non-small cell lung cancer |
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Authors: | Yu Nakanishi Takeshi Masuda Kakuhiro Yamaguchi Shinjiro Sakamoto Yasushi Horimasu Taku Nakashima Shintaro Miyamoto Yasuhiro Tsutani Hiroshi Iwamoto Kazunori Fujitaka Yoshihiro Miyata Hironobu Hamada Morihito Okada Noboru Hattori |
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Affiliation: | 1. Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan;2. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan |
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Abstract: | BackgroundApproximately 5% of non-small cell lung cancer (NSCLC) patients develop immune checkpoint inhibitor (ICI)-induced interstitial lung disease (ICI-ILD), 10% of whom die. However, there are no established risk factors for its occurrence. Interstitial lung abnormalities (ILA) are areas of increased lung density on lung computed tomography (CT) in individuals with no known ILD. This study retrospectively investigated whether any patient characteristics, including ILA, were risk factors for ICI-ILD in patients with NSCLC.MethodsNSCLC patients who received anti-programmed death (PD)-1 antibody treatment at our hospital between September 2015 and December 2017 were enrolled. Information on patient characteristics before anti-PD-1 antibody administration, including chest CT findings and laboratory data, were obtained.ResultsAmong 83 enrolled patients, the incidence of ICI-ILD was 16.9% (14/83). All ICI-ILD cases developed by the third line of treatment. The incidence of ICI-ILD was significantly higher in patients with pre-existing ILA than that in those without (p = 0.007). Furthermore, patients with ground glass attenuation (GGA) in ILA had a higher incidence of ICI-ILD than that in those without (p < 0.001). In univariate logistic analysis, ILA were significant risk factors for ICI-ILD (p = 0.005). Multivariate logistic analysis revealed that only GGA in ILA was a significant risk factor for ICI-ILD (p < 0.001).ConclusionsPre-existing ILA are risk factors for ICI-ILD and GGA in ILA is an independent risk factor for ICI-ILD. Therefore, we should be more aware of the development of ICI-ILD in patients with ILA, especially those with GGA. |
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Keywords: | Corresponding author. Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. Immune checkpoint inhibitors Anti-PD-1 antibody Immune-related adverse events Interstitial lung abnormalities Ground glass attenuation NSCLC non-small cell lung cancer ICI-ILD immune checkpoint inhibitor (ICI)-induced interstitial lung disease ILA interstitial lung abnormalities CT computed tomography PD programmed death GGA ground glass attenuation ir-AEs immune-related adverse events HRCT high-resolution CT UIP usual interstitial pneumonia NSIP non-specific interstitial pneumonia OP organizing pneumonia OR odds ratio CI confidence interval |
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