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      Immune Checkpoint Inhibitor-Related Pneumonitis in Lung Cancer Patients with Interstitial Lung Disease: Significance of Radiological Pleuroparenchymal Fibroelastosis

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          Abstract

          Introduction: Pleuroparenchymal fibroelastosis (PPFE) findings are associated with poor prognosis in interstitial lung disease (ILD). However, the effect of PPFE findings on the development of immune checkpoint inhibitor-related pneumonitis (ICI-pneumonitis), a life-threatening adverse event, in lung cancer patients with ILD has not been elucidated. We aimed to determine whether PPFE findings are a risk factor for ICI-pneumonitis in lung cancer patients with ILD. Methods: We retrospectively examined 712 lung cancer patients, including 173 patients with background ILDs, who received ICI therapy in our institute between December 2015 and May 2021. Background ILDs were radiologically classified into three types: lone PPFE, other ILDs with PPFE, and other ILDs without PPFE. The cumulative ICI-pneumonitis incidence curves and median overall survival (mOS) were compared between the three radiological types, and risk factors for ICI-pneumonitis were evaluated. Results: Of 173 eligible patients with ILD, 23 patients (13.3%) experienced ICI-pneumonitis. The Kaplan-Meier method and the log-rank test showed that lone PPFE patients had significantly lower incidence of ICI-pneumonitis ( p = 0.024) and longer mOS (575 vs. 326 days; p = 0.0096) than other ILDs patients. ICI-pneumonitis ( p = 0.35) and mOS ( p = 0.29) were not significantly different between other ILDs with and without PPFE. A multivariate Cox proportional hazards regression analysis revealed that lone PPFE pattern was an independent predictive factor for ICI-pneumonitis (hazard ratio, 0.20; 95% confidence interval, 0.043–0.93; p = 0.040). Conclusion: ICI therapy could be safer in lone PPFE patients than in other ILDs patients with lung cancer.

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          Author and article information

          Journal
          OCL
          Oncology
          10.1159/issn.0030-2414
          Oncology
          Oncology
          S. Karger AG
          0030-2414
          1423-0232
          2023
          May 2023
          23 January 2023
          : 101
          : 5
          : 303-312
          Affiliations
          [_a] aDepartment of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
          [_b] bClinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
          [_c] cDepartment of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
          Author notes
          *Yoshikazu Inoue, giichiyi@me.com
          Author information
          https://orcid.org/0000-0002-3230-3431
          https://orcid.org/0000-0002-2222-0683
          https://orcid.org/0000-0002-3229-1725
          https://orcid.org/0000-0003-3994-874X
          Article
          529204 Oncology 2023;101:303–312
          10.1159/000529204
          36689929
          0facd938-ad7a-4e7c-b44a-e1f89f843078
          © 2023 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

          History
          : 25 September 2022
          : 28 December 2022
          Page count
          Figures: 4, Tables: 3, Pages: 10
          Funding
          The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
          Categories
          Clinical Study

          Medicine
          Lung neoplasms,Interstitial lung abnormalities,Immune checkpoint inhibitor,Pleuroparenchymal fibroelastosis,Interstitial lung disease

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