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Clinical Outcomes of Anti-programmed Death-1 Antibody–Related Pneumonitis in Patients with Non-Small Cell Lung Cancer

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Abstract

Immune checkpoint inhibitors have provided a breakthrough in cancer therapy. Pneumonitis related to immune checkpoint inhibitors is a serious immune-related adverse event that can be fatal. However, the response to corticosteroids and clinical course of pneumonitis remain poorly understood. We retrospectively reviewed the records of patients who received monotherapy with anti-programmed death 1 (PD-1) antibody, nivolumab, or pembrolizumab, and examined cases with anti-PD-1 antibody-related pneumonitis. The incidence, response to treatment, and recurrence of pneumonitis were investigated. Of 592 patients who received nivolumab or pembrolizumab, 79 developed anti-PD-1 antibody-related pneumonitis. The incidence of all-grade and grade 3–5 pneumonitis was 13.3% and 5.1%, respectively. Despite corticosteroid therapy, 16.5% of pneumonitis cases did not improve, which occurred significantly more frequently in patients with poor performance status, low serum albumin level, and pleural effusion. Among patients with improved pneumonitis, 12.3% experienced recurrence of pneumonitis without re-administration of anti-PD-1 antibody. Anti-PD-1 antibody was re-administered in 16 patients after initial clinical improvement, and five (31.2%) patients experienced a second recurrence of pneumonitis. The incidence of pneumonitis was not rare in real-world settings. Even after improvement of pneumonitis, pneumonitis flare can occur with and without PD-1 antibody re-administration.

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Acknowledgments

We thank Cathel Kerr, BSC, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan

    Takafumi Koyauchi, Naoki Inui, Masato Karayama, Hideki Yasui, Hironao Hozumi, Yuzo Suzuki, Kazuki Furuhashi, Tomoyuki Fujisawa, Noriyuki Enomoto, Yutaro Nakamura & Takafumi Suda

  2. Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan

    Naoki Inui

  3. Department of Respiratory Medicine, Iwata City Hospital, 513-2 Ohkubo, Iwata, 438-8550, Japan

    Yoshihiro Kitahara & Tomohiro Uto

  4. Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, 1-1-1 Oshika, Shizuoka, 422-8527, Japan

    Sho Takuma & Hideki Kusagaya

  5. Department of Respiratory Medicine, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, 433-8558, Japan

    Yusuke Amano & Takashi Matsui

  6. Department of Respiratory Medicine, Hamamatsu Medical Center, 328 Tomitsuka, Hamamatsu, 432-8580, Japan

    Mitsuru Niwa

  7. Department of Respiratory Medicine, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shizuoka, 424-8636, Japan

    Nao Inami

  8. Department of Respiratory Medicine, Tenryu Hospital, 4201-2 Oro, Hamamatsu, 434-8511, Japan

    Yasuhiro Ito

  9. Department of Respiratory Medicine, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, 426-8677, Japan

    Shun Matsuura

  10. Department of Respiratory Medicine, Ensyu Hospital, 1-1-1 Chuou, Hamamatsu, 430-0929, Japan

    Yusuke Kaida

  11. Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi-cho, Hamamatsu, 430-8558, Japan

    Dai Hashimoto

  12. Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-ando, Shizuoka, 420-0881, Japan

    Kazuhiro Asada

  13. Department of Respiratory Medicine, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi, Shizuoka, 420-0853, Japan

    Hiroyuki Matsuda

  14. Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, 10-93 Ote-cho, Shizuoka, 420-8630, Japan

    Masato Fujii

  15. Department of Respiratory Medicine, Hamamatsu Rosai Hospital, 25 Shougen-cho, Hamamatsu, 430-8525, Japan

    Mikio Toyoshima

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  1. Takafumi Koyauchi
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  2. Naoki Inui
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  19. Yusuke Kaida
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  20. Tomohiro Uto
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  27. Takafumi Suda
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Corresponding author

Correspondence to Naoki Inui.

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Koyauchi, T., Inui, N., Karayama, M. et al. Clinical Outcomes of Anti-programmed Death-1 Antibody–Related Pneumonitis in Patients with Non-Small Cell Lung Cancer. SN Compr. Clin. Med. 2, 570–578 (2020). https://doi.org/10.1007/s42399-020-00259-3

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