Analysis on influencing factors of immune checkpoint inhibitor-related pneumonitis induced by PD-1/PD-L1 inhibitors
10.3760/cma.j.cn114015-20221107-01035
- VernacularTitle:PD-1/PD-L1免疫检查点抑制剂相关性肺炎的影响因素研究
- Author:
Junying CAI
1
;
Wanwen CHEN
;
Yuwen HE
Author Information
1. 广州医科大学药学院，广州 511436
- Publication Type:Journal Article
- Keywords:
Immune checkpoint inhibitors;
Programmed cell death 1 receptor;
Pneumonia;
Risk factors;
Logistic models
- From:
Adverse Drug Reactions Journal
2023;25(4):204-210
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the influencing factors of immune checkpoint inhibitor-related pneumonitis (CIP) in lung cancer patients caused by programmed cell death 1 receptor (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors.Methods:A retrospective analysis was conducted on clinical data of lung cancer patients treated with PD-1/PD-L1 inhibitors in the First Affiliated Hospital of Guangzhou Medical University from January 2018 to June 2022. Patients with CIP were included in the CIP group, and those who did not experience any immune-related adverse events during the same period were screened in a 1∶1 ratio and included in the control group. The clinical characteristics in patients of the 2 groups were compared and influencing factors of CIP were analyzed using binary logistic regression method. The effect sizes were the odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 246 patients (123 in the CIP group and 123 in the control group) were entered in the analysis, including 208 males and 38 females, aged (63±9) years with a range of 32 to 86 years. The diagnosis was non-small-cell lung cancer in 234 patients and small cell lung cancer in 12 patients. There were no statistically significant differences in age, gender, history of respiratory diseases, tumor histological types, TNM stages, and types of immune checkpoint inhibitors used in patients between the 2 groups (all P>0.05). Compared with the control group, patients in the CIP group had a lower body mass index [(21.5±3.2) kg/m 2vs. (22.6±3.0) kg/m 2, P=0.004], higher proportion of patients with Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) ≥2 points[39.0% (48/123) vs. 22.0% (27/123), P=0.004], higher proportion of patients with a history of radiation therapy [25.2% (31/123) vs. 13.8% (17/123), P=0.024], and lower proportion of patients with combination therapy with chemotherapy/targeted drugs[82.9%(102/123) vs. 97.6%(120/123), P<0.001]. Before immunotherapy, the peripheral blood interleukin-1β and interferon-α were lower [1.97 (1.04, 2.74) ng/L vs. 2.40 (1.75, 4.03) ng/L, P=0.021; 2.08 (0.89, 3.00) ng/L vs. 2.76 (1.97, 3.94) ng/L, P=0.012], lymphocyte count was lower [1.4(1.0, 1.8)×10 9/L vs. 1.5(1.2, 2.1)×10 9/L, P=0.030], and the neutrophil-to-lymphocyte ratio was higher [3.85 (2.50, 6.40) vs. 3.11 (2.25, 4.61), P=0.006] in patients of the CIP group than those in the control group. The binary logistic regression analysis showed that baseline ECOG-PS ≥2 points ( OR=3.400, 95% CI: 1.180-9.798, P=0.023) and combination of PD-1/PD-L1 inhibitors and chemotherapy/targeted therapy ( OR=0.047, 95% CI: 0.005-0.454, P=0.008) were independent influencing factors for the occurrence of CIP. Conclusion:The ECOG-PS ≥ 2 points before immunotherapy is an influencing factor for CIP, and the combination with chemotherapy/targeted therapy may reduce the risk of developing CIP in patients treated with PD-1/PD-L1 inhibitors.
