Abstract 246P
Background
Many cancer treatments are associated with potentially life-threatening drug-induced interstitial lung disease (DIILD), also known as drug-related pneumonitis. Chest CT scan is used for screening and monitoring DIILD in patients on high-risk treatment, but is often inconclusive in suspected cases. Therefore, a non-invasive, rapid, and accessible test to facilitate frequent monitoring, timely diagnosis and adequate treatment of DIILD is needed. Electronic nose (eNose) analyzes exhaled breath in real-time. We showed previously that eNose has potential as point-of-care test to detect ILD. We investigated whether eNose technology can differentiate between patients with cancer who have DIILD and those without DIILD.
Methods
In a cross-sectional study, patients with a pathology-proven solid cancer diagnosis and suspected DIILD were included as cases. After inclusion, cases were discussed within a multidisciplinary team and excluded if DIILD was rejected. Patients without DIILD served as controls, matched for cancer diagnosis and treatment. Exhaled breath analysis using eNose (SpiroNose®) was performed. Data were analyzed using sparse partial least squares discriminant and receiver operating characteristic analyses.
Results
Twenty patients in both case and control group were included, of whom 40% had lung cancer. DIILD occurred at median 2.8 [1.5, 6.1] months after start of cause-related treatment and 11 (55%) cases received steroids for DIILD. All baseline characteristics are displayed in the table. Comparing eNose data of both groups resulted in an area under the curve of 0.81 (95%CI 0.67-0.95) with corresponding sensitivity and specificity of 0.75.
Table: 246P
Baseline
| Case n=20 | Control n=20 | |
| Female | 9 (45) | 9 (45) |
| Age | 65.25 ±11.67 | 67.6 ±9.4 |
| Smoking: | ||
| Never | 3 (15) | 7 (35) |
| Former | 17 (85) | 13 (65) |
| Cancer diagnosis: | ||
| Lung | 8 (40) | 8 (40) |
| Urogenital | 5 (25) | 5 (25) |
| Melanoma | 4 (20) | 4 (20) |
| Mesothelioma | 3 (15) | 3 (15) |
| Treatment: | ||
| Nivolumab (ipilimumab) | 8 (40) | 8 (40) |
| Pembrolizumab, pemetrexed, carboplatin | 4 (20) | 4 (20) |
| Sotorasib | 2 (10) | 2 (10) |
| Capmatinib | 1 (5) | 1 (5) |
| Dabrafenib, trametinib | 1 (5) | 1 (5) |
| Gemcitabine (carboplatin) | 1 (5) | 1 (5) |
| GEN1046-04 (pembrolizumab) | 1 (5) | 1 (5) |
| Osimertinib | 1 (5) | 1 (5) |
| Taxane | 1 (5) | 1 (5) |
| Start treatment to DIILD (mo) | 2.8 [1.5,6.1] | |
| Steroid use | 11 (55) | |
| MDT likelihood DIILD: | ||
| 51-69% | 2 (10) | |
| 71-89% | 8 (40) | |
| ≥90% | 10 (50) | |
| CTCAE DIILD: | ||
| I-II | 8 (40) | |
| III-IV | 9 (45) | |
| V | 3 (15) |
Conclusions
In a cohort of patients with various types of cancer and treatment, eNose technology seems to distinguish patients with and without DIILD. These findings encourage validation of eNose for identification of DIILD, in the current era of expanding access to pulmonary toxic cancer treatments.
Legal entity responsible for the study
Erasmus MC - University Medical Center.
Funding
AstraZeneca/Daiichi Sankyo.
Disclosure
I.G. Van der Sar: Financial Interests, Institutional, Research Grant: Boehringer Ingelheim. M. Wijsenbeek: Financial Interests, Institutional, Research Grant: The Netherlands Organisation for Health Research and Development, The Dutch Lung Foundation, The Dutch Pulmonary Fibrosis organization, Sarcoidosis.nl, Boehringer Ingelheim, Hoffman la Roche, AstraZeneca, Daiichi Sankyo; Financial Interests, Institutional, Advisory Role: AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Galapagos, Galecto, GSK, Hoffman la Roche, Horizon therapeutics, Kinevant Sciences, Molecure, Nerre Therapeutics, Novartis, PureTech Health, Thyron, Trevi, and Vicore; Financial Interests, Institutional, Invited Speaker: Boehringer Ingelheim, Hoffman la Roche, AstraZeneca, Daiichi Sankyo; Financial Interests, Institutional, Other, Travel Reimbursement: Boehringer Ingelheim, GSK, Hoffman la Roche, and Galapagos; Financial Interests, Institutional, Advisory Board: Galapagos; Non-Financial Interests, Personal, Leadership Role: Idiopathic Interstitial Pneumonia group of the European Respiratory Society; Netherlands Respiratory Society; European Idiopathic Pulmonary Fibrosis and related disorders federation; European Reference Network for rare Lung Diseases; Dutch Lungfibrosis an. D. Dumoulin: Financial Interests, Personal, Other, Personal Fees: MSD, Amgen, Roche, BMS, Pfizer. A.A.M. van der Veldt: Financial Interests, Institutional, Advisory Role: Eisai, Ipsen, BMS, MSD, Sanofi, Pierre Fabre, Novartis, Pfizer, Roche. A.C. Dingemans: Financial Interests, Institutional, Advisory Board: Roche, Amgen, Bayer, AstraZeneca, Boehringer Ingelheim, Janssen; Financial Interests, Institutional, Invited Speaker: Lilly, Janssen, Lilly, Amgen, Daiichi Sankyo, Roche, Roche, JNJ, Mirati; Financial Interests, Institutional, Other, IDMC: Roche; Financial Interests, Institutional, Expert Testimony: Mirati; Financial Interests, Institutional, Research Grant: Amgen; Non-Financial Interests, Personal, Other, Chair EORTC lung cancer group: EORTC; Non-Financial Interests, Personal, Member: IASCL, ASCO, AACR. C. Moor: Financial Interests, Institutional, Research Grant: Boehringer Ingelheim, AstraZeneca and Daiichi Sankyo. All other authors have declared no conflicts of interest.