Immune checkpoint inhibitors(ICIs)are new and promising therapeutic agents for non-small cell lung cancer(NSCLC).However,along with demonstrating remarkable efficacy,ICIs can also trigger immune-related adverse events...Immune checkpoint inhibitors(ICIs)are new and promising therapeutic agents for non-small cell lung cancer(NSCLC).However,along with demonstrating remarkable efficacy,ICIs can also trigger immune-related adverse events.Checkpoint inhibitor pneumonitis(CIP)has been reported to have a morbidity rate of 3%to 5%and a mortality rate of 10%to 17%.Moreover,the incidence of CIP in NSCLC is higher than that in other tumor types,reaching 7%to 13%.With the increased use of ICIs in NSCLC,CIP has drawn extensive attention from oncologists and cancer researchers.Identifying high risk factors for CIP and the potential mechanism of CIP are key points in preventing and monitoring serious adverse events.In this review,the results of our analysis and summary of previous studies suggested that the risk factors for CIP may include previous lung disease,prior thoracic irradiation,and combinations with other drugs.Our review also explored potential mechanisms closely related toCIP,including increasedT cell activity against associated antigens in tumor and normal tissues,preexisting autoantibodies,and inflammatory cytokines.展开更多
BACKGROUND As immune checkpoint inhibitors(ICIs)have become widely used in lung cancer treatment,immune-related adverse events(irAEs)warrant sufficient attention.Checkpoint inhibitor-related pneumonitis(CIP)is one of ...BACKGROUND As immune checkpoint inhibitors(ICIs)have become widely used in lung cancer treatment,immune-related adverse events(irAEs)warrant sufficient attention.Checkpoint inhibitor-related pneumonitis(CIP)is one of the most concerning adverse events as it is uncommon but life threatening.CASE SUMMARY The patient whose case is reported here experienced three episodes of CIP in a span of 4 mon.Interestingly,the three episodes of CIP involved different regions of the lung separately.Taking these pneumonitis areas together makes nearly a whole lung area.CONCLUSION This case showed that recurrent CIPs may occur repeatedly until the whole lung is involved,suggesting that the follow-up period of CIP should be long enough,and the rechallenge of ICI should be done with due caution.展开更多
目的:探讨非小细胞肺癌(NSCLC)患者接受免疫检查点抑制剂(ICIs)治疗后发生检查点抑制剂肺炎(CIP)的相关因素,并确定CIP及其相关因素与患者临床疗效的相关性。方法:回顾性分析2019年9月1日-2022年9月1日在解放军联勤保障部队第960医院和...目的:探讨非小细胞肺癌(NSCLC)患者接受免疫检查点抑制剂(ICIs)治疗后发生检查点抑制剂肺炎(CIP)的相关因素,并确定CIP及其相关因素与患者临床疗效的相关性。方法:回顾性分析2019年9月1日-2022年9月1日在解放军联勤保障部队第960医院和山东省第二人民医院接受ICIs治疗的NSCLC患者临床资料。将患者分为发生CIP组与未发生CIP组两组,随后将发生CIP的患者分为低级别CIP与高级别CIP两个亚组。Kaplan-Meier法统计无进展生存期(PFS)和总生存期(OS)。单因素和多因素Cox风险比例回归模型分析预后相关因素,采用受试者工作曲线(ROC)确定外周血循环标记物诊断CIP的最佳截断值。结果:在接受ICIs治疗的患者中共有34例(34/143,23.8%)患者发生了CIP,与非CIP患者相比无进展生存期(PFS)延长(18 vs 10个月,P=0.002),总生存期(OS)无统计学差异(24 vs 37个月,P=0.176)。亚组分析表明低级别CIP患者与高级别CIP患者相比,PFS(22 vs 4个月,P<0.001)及OS延长(27 vs 13个月,P=0.004)。外周血标记物NPR、NLR、CRP及中性粒细胞预测CIP发生的最佳临界值分别为0.018(AUC=0.677)、4.976(AUC=0.651)、8.800(AUC=0.750)、6.105(AUC=0.640),进一步分析显示高NLR与OS降低相关(P=0.001)。结论:在接受ICIs治疗的NSCLC患者中,CIP的发生与临床获益相关,发生低级别CIP的患者表现出更好的临床结果,而NPR,NLR、CRP以及中性粒细胞可作为CIP预测指标。高NLR与预后不良相关。展开更多
基金This work was supported by a grant from the Wu Jieping Medical Foundation(Grant No.320675018288).
文摘Immune checkpoint inhibitors(ICIs)are new and promising therapeutic agents for non-small cell lung cancer(NSCLC).However,along with demonstrating remarkable efficacy,ICIs can also trigger immune-related adverse events.Checkpoint inhibitor pneumonitis(CIP)has been reported to have a morbidity rate of 3%to 5%and a mortality rate of 10%to 17%.Moreover,the incidence of CIP in NSCLC is higher than that in other tumor types,reaching 7%to 13%.With the increased use of ICIs in NSCLC,CIP has drawn extensive attention from oncologists and cancer researchers.Identifying high risk factors for CIP and the potential mechanism of CIP are key points in preventing and monitoring serious adverse events.In this review,the results of our analysis and summary of previous studies suggested that the risk factors for CIP may include previous lung disease,prior thoracic irradiation,and combinations with other drugs.Our review also explored potential mechanisms closely related toCIP,including increasedT cell activity against associated antigens in tumor and normal tissues,preexisting autoantibodies,and inflammatory cytokines.
文摘BACKGROUND As immune checkpoint inhibitors(ICIs)have become widely used in lung cancer treatment,immune-related adverse events(irAEs)warrant sufficient attention.Checkpoint inhibitor-related pneumonitis(CIP)is one of the most concerning adverse events as it is uncommon but life threatening.CASE SUMMARY The patient whose case is reported here experienced three episodes of CIP in a span of 4 mon.Interestingly,the three episodes of CIP involved different regions of the lung separately.Taking these pneumonitis areas together makes nearly a whole lung area.CONCLUSION This case showed that recurrent CIPs may occur repeatedly until the whole lung is involved,suggesting that the follow-up period of CIP should be long enough,and the rechallenge of ICI should be done with due caution.
文摘目的:探讨非小细胞肺癌(NSCLC)患者接受免疫检查点抑制剂(ICIs)治疗后发生检查点抑制剂肺炎(CIP)的相关因素,并确定CIP及其相关因素与患者临床疗效的相关性。方法:回顾性分析2019年9月1日-2022年9月1日在解放军联勤保障部队第960医院和山东省第二人民医院接受ICIs治疗的NSCLC患者临床资料。将患者分为发生CIP组与未发生CIP组两组,随后将发生CIP的患者分为低级别CIP与高级别CIP两个亚组。Kaplan-Meier法统计无进展生存期(PFS)和总生存期(OS)。单因素和多因素Cox风险比例回归模型分析预后相关因素,采用受试者工作曲线(ROC)确定外周血循环标记物诊断CIP的最佳截断值。结果:在接受ICIs治疗的患者中共有34例(34/143,23.8%)患者发生了CIP,与非CIP患者相比无进展生存期(PFS)延长(18 vs 10个月,P=0.002),总生存期(OS)无统计学差异(24 vs 37个月,P=0.176)。亚组分析表明低级别CIP患者与高级别CIP患者相比,PFS(22 vs 4个月,P<0.001)及OS延长(27 vs 13个月,P=0.004)。外周血标记物NPR、NLR、CRP及中性粒细胞预测CIP发生的最佳临界值分别为0.018(AUC=0.677)、4.976(AUC=0.651)、8.800(AUC=0.750)、6.105(AUC=0.640),进一步分析显示高NLR与OS降低相关(P=0.001)。结论:在接受ICIs治疗的NSCLC患者中,CIP的发生与临床获益相关,发生低级别CIP的患者表现出更好的临床结果,而NPR,NLR、CRP以及中性粒细胞可作为CIP预测指标。高NLR与预后不良相关。
