Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases,Chest

当前位置： X-MOL 学术 › Chest › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Clinical Outcomes of Immune Checkpoint Inhibitor Therapy in Patients With Advanced Non-small Cell Lung Cancer and Preexisting Interstitial Lung Diseases
Chest ( IF 9.5 ) Pub Date : 2022-01-11 , DOI: 10.1016/j.chest.2021.12.656
Meng Zhang ₁ , Yong Fan ₂ , Ligong Nie ₁ , Guangfa Wang ₁ , Kunyan Sun ₁ , Yuan Cheng ₁

Affiliation

Background

Patients with non-small cell lung cancer (NSCLC) and preexisting interstitial lung disease (ILD) are often excluded from clinical trials of immune checkpoint inhibitors (ICIs), leaving a gap in knowledge.

Research Question

What are the clinical outcomes of ICIs in patients with NSCLC and preexisting ILD?

Study Design and Methods

Systematic searches were conducted of PubMed, EMBASE, and Cochrane Library through April 2021 with no language or study design restrictions. Studies reporting the safety and efficacy data among patients with cancer and ILD receiving ICI therapy were collected. The primary end points were clinical efficacy to immunotherapy and the incidence of immune-related adverse events, especially for checkpoint inhibitor pneumonitis (CIP).

Results

A total of 179 patients in 10 studies were included. The pooled overall response rate (ORR) and pooled disease control rate (DCR) were 34% (95% CI, 20-47) and 66% (95% CI, 56-75), respectively. The ORR in patients with preexisting ILD was significantly higher than that in patients without ILD (OR, 1.99; 95% CI, 1.31-3.00). The DCR and progression-free survival in patients with preexisting ILD were not inferior to those without ILD (pooled OR, 1.46; 95% CI, 0.94-2.25 for DCR). The pooled incidences of any grade and grade 3 or higher CIP were 27% (95% CI, 17-37) and 15% (95% CI, 9-22) in patients with preexisting ILD, and 10% (95% CI, 6-13) and 4% (95% CI, 2-6) in patients without ILD. Meta-analysis found a significantly higher incidence rate of any grade and grade 3 or higher CIP in patients with NSCLC and preexisting ILD than in those patients without ILD (OR, 3.23 [95% CI, 2.06-5.06]; OR, 2.91 [95% CI, 1.47-5.74]).

Interpretation

Programmed cell death protein 1/programmed cell death ligand 1 inhibitors had favorable efficacy in NSCLC with preexisting ILD. CIP is frequent in patients with preexisting ILD who receive ICI therapy but is often mild and easily manageable. Clinicians should be cautious when using ICIs in patients with preexisting ILD.

中文翻译：

免疫检查点抑制剂治疗晚期非小细胞肺癌和既存间质性肺病患者的临床结果

背景

患有非小细胞肺癌（NSCLC）和既往间质性肺疾病（ILD）的患者通常被排除在免疫检查点抑制剂（ICIs）的临床试验之外，从而留下了知识空白。

研究问题

ICI 对 NSCLC 和既往 ILD 患者的临床结果是什么？

研究设计和方法

截至 2021 年 4 月，我们对 PubMed、EMBASE 和 Cochrane 图书馆进行了系统检索，没有语言或研究设计限制。收集了报告接受 ICI 治疗的癌症和 ILD 患者的安全性和有效性数据的研究。主要终点是免疫治疗的临床疗效和免疫相关不良事件的发生率，特别是检查点抑制剂肺炎（CIP）。

结果

10 项研究共纳入 179 名患者。汇总总体缓解率 (ORR) 和汇总疾病控制率 (DCR) 分别为 34% (95% CI, 20-47) 和 66% (95% CI, 56-75)。既往患有 ILD 的患者的 ORR 显着高于无 ILD 的患者（OR，1.99；95% CI，1.31-3.00）。既往存在 ILD 的患者的 DCR 和无进展生存期并不逊色于无 ILD 的患者（合并 OR，1.46；95% CI，DCR 为 0.94-2.25）。在既往存在 ILD 的患者中，任何级别和 3 级或以上 CIP 的汇总发生率分别为 27% (95% CI, 17-37) 和 15% (95% CI, 9-22)，以及 10% (95% CI, 9-22)。 6-13) 和无 ILD 患者中 4% (95% CI, 2-6)。荟萃分析发现，NSCLC 和既往存在 ILD 的患者中任何级别和 3 级或以上 CIP 的发生率显着高于无 ILD 的患者（OR，3.23 [95% CI，2.06-5.06]；OR，2.91 [95] % CI，1.47-5.74]）。