The following is a summary of “Impact of Baseline Interstitial Lung Abnormalities on Pneumonitis Risk in Patients Receiving Immune Checkpoint Inhibitors for Non–Small-Cell Lung Cancer,” published in the December 2023  issue of Pulmonology by Petranovic, et al.

Immune-related pneumonitis is a side effect of immune checkpoint inhibitors (ICIs) that can be deadly. People who have interstitial lung disease (ILD) are more likely to get pneumonitis. However, the effects of interstitial abnormalities (ILA) without ILD have yet to be fully studied. For a study, researchers sought to look at how ILA on chest computed tomography (CT) studies before treatment related to the chance of pneumonitis in people with non–non-small-cell lung cancer (NSCLC). They looked at all the adult patients who got ICI at their hospital for NSCLC between January 2013 and January 2020. 

Two thoracic doctors who were not aware of the clinical results looked at pre-ICI chest CTs on their own to find and classify ILA using standards that had already been published. They used univariate and multivariate analysis, considering age, radiation exposure, and smoking status, to look for links between ILA, clinicopathologic features, and clinical (CTCAE grade ≥2) pneumonitis. Out of 475 patients who met the standards for ICI treatment, 78 (16.4%) already had ILA at the start, most often showing up as a subpleural nonfibrotic pattern. 

Of 475 cases, 43 (9.1%) got pneumonitis with symptoms. 16.7% of people with ILA got pneumonia. Still, only 7.6% of people without ILA did (P <.05). A higher chance of getting pneumonitis was linked to having ground glass and having a lot of lung parenchymal involvement. In an adjusted study, baseline ILA was still linked to a higher chance of clinical pneumonitis (OR 2.2, 95% CI, 1.0–4.5). Patients with NSCLC who are being treated with ICI are more likely to acquire severe pneumonitis if they have baseline ILAs. More research needed to be done to confirm these findings.

Source: sciencedirect.com/science/article/abs/pii/S1525730423001791