Abstract 2181P
Background
Immune checkpoint inhibitor (ICIs) has opened a new era in the treatment of malignant tumors, but its clinical application has been severely hindered by various immune-related adverse events. Checkpoint inhibitors pneumonitis (CIP) is one of the most common fatal adverse events.The current guideline-recommended treatment strategies are difficult to achieve precise treatment and efficient coverage of CIP. The optimal timing of ICIs suspension and the initiation and dose of corticosteroids still need to be optimized.
Methods
A total of 121 CIP patients of 672 cancer patients were retrospectively analyzed. The detailed treatment process of CIP patients was recorded. Radiographic changes combined with clinical symptoms classified the outcome of CIP into worsening, stable, and improved.
Results
No association were found between continued ICIs after the diagnosis of CIP and worsened outcome in G1 CIP (p=0.296), but continued ICIs treatment was associated with worse outcomes in G2-4 CIP (p=0.009, adjusted p=0.012). For G2 CIP, prompt corticosteroid treatment is closely related with an improved outcome (p=0.015). Initiating corticosteroid in the acute phase is strongly associated with an improved outcome in G2-4 CIP (p=0.021, adjusted p=0.013). Furthermore, patients in the low-dose corticosteroid group were not only conducive to an improved outcome (p=0.024, adjusted p=0.016), but also reduced the risk of residual irreversible fibrotic lesions in G2-4 CIP (p=0.016, adjusted p=0.018).
Conclusions
For G1 CIP, ICIs may be continued conservatively and its safety is manageable. For G2-4 CIP, ICIs should be terminated and corticosteroid therapy initiated as soon as possible after diagnosis to avoid irreversible damage to lung function. Furthermore, initial low doses of corticosteroids(<1mg/kg/d) appear to be more conducive to favorable outcomes than high doses of corticosteroids.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
This work was supported by Outstanding Youth Project of Shaanxi Province (2020JC-35), Research and development projects in Shaanxi Province (2022ZDLSF04-11), Natural Science Foundation of Shaanxi Province (2022JQ-796), Major project of innovation Fund of Chinese Society of Clinical Oncology-MSD (Y-MSD2020-024), Shaanxi Sanqin Scholars Innovation Team (2021-No. 32), Beijing Science Innovation Medical Development Fund (KC2021-JX-0186-5) and National Natural Science Foundation of China (No. 82272073).
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
2194P - Prospective observational study of physical activity measurement using wearable device as an alternative to ECOG PS in patients with advanced lung cancer
Presenter: Kentaro Ito
Session: Poster session 07
Resources:
Abstract
2195P - Targeted gene editing with CRISPR for the treatment of pleural mesothelioma
Presenter: Rodrigo Dominic Cerqueda
Session: Poster session 07
2196P - PET-CT detects response to treatment with ipilimumab and nivolumab in malignant mesothelioma far better than CT
Presenter: Daniel C. Christoph
Session: Poster session 07
2197P - Prognostic value of 18F-FDG-PET for patients with malignant pleural mesothelioma treated with double immunotherapy
Presenter: Solfrid Thunold
Session: Poster session 07
2198P - Clinicopathologic characteristics and outcomes to immune checkpoint inhibitor therapy in patients with HER2-altered metastatic non-small cell lung cancer
Presenter: Maisam Makarem
Session: Poster session 07
2199P - Immunohistochemical identification of clinical subtypes and potential therapeutic vulnerabilities of lung carcinoids based on multi-omic analysis
Presenter: Jules Derks
Session: Poster session 07
2200P - Spatiotemporal distribution of mediastinal neoplasms: A multi-center, hospital-based, systematic analysis
Presenter: Yu Jiang
Session: Poster session 07
2201P - Malignant pleural mesothelioma (MPM)-specific DNA methylation patterns in patients using liquid biopsies
Presenter: Sabine Schmid
Session: Poster session 07
2202P - Large cell neuroendocrine carcinoma (LCNEC) subtyping based on NEUROD1, ASCL1, POU2F3 and YAP1 expression
Presenter: Frank Heijboer
Session: Poster session 07
2203P - Uncovering prognostic transcriptomic differences in epithelioid malignant pleural mesothelioma
Presenter: Mario Occhipinti
Session: Poster session 07