Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events. Rechallenge after a first episode of ILD remains controversial.
We conducted a multicenter retrospective cohort study of ICIs rechallenge after a first episode of an ICI-associated with interstitial lung disease (ICI-ILD). The objective was to evaluate the safety and efficacy of immunotherapy rechallenge.
Thirty-two patients were included and were initially treated with anti-PD-1 monotherapy (84.4%) or in combination with anti-CTLA-4 (15.6%) and experienced grade 1 (25%), grade 2 (56.2%) grade 3 (18,8%) ICI-ILD. Most patients (90.6%) were rechallenged with anti-PD-1 monotherapy. Thirteen patients (40.6%) experienced ILD recurrence following rechallenge. Median time to recurrence of ICI-ILD after ICI rechallenge was shorter for the recurrence vs for the first episode: 0.9 (range: 0.2-8.3) vs 3.0 (0.03-35.7) months. The second episode of ICI-ILD appeared to be more severe than the first one, regarding both symptoms (38.5% vs 18.8 % of grade ≥ 3 ILD), and radiological features (higher number of lobes and intensity of CT-scan lesions after centralized review). One ICI-ILD related death was reported. 53.8% of patients recurred with a similar radiological pattern. Steroids use during rechallenge was not associated with ICI-ILD recurrence risk. Objective response rate and disease stabilization under ICI rechallenge were at 18.8% and 34.4%. Progression free survival and overall survival were not statistically different in patients who experienced ICI-ILD recurrence vs not. Three months after the rechallenge, 15 patients (46.9%) had progressive disease: 55.6% in the recurrence group and 43.6% in the no recurrence group.
40.6% of patients had a recurrence of ICI-ILD after rechallenge with ICI. The second episode of ICI-ILD appears to have similar radiological patterns but to be more severe and to occur earlier than the first one.
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Has not received any funding.
All authors have declared no conflicts of interest.