Risk factors and clinical outcomes of immune checkpoint inhibitor-related pneumonitis in patients with advanced non-small cell lung cancer：A single center experience

Purpose: Immune checkpoint inhibitors (ICIs) can lead to pneumonitis, a potentially fatal complication. Identifying patients at risk of immune checkpoint inhibitor-related pneumonitis (CIP) prior to starting ICIs treatment is essential for managing CIP. We conducted this study with the purpose of determining the prognosis and risk factors for CIP. Methods: In this study, 360 patients with non-small cell lung cancer (NSCLC) who underwent anti-programmed cell death-1/-ligand 1 (PD-1/PD-L1) inhibitors for at least one dose from 2019 to 2022 at Hubei Cancer Hospital were included. Risk factors correlated with CIP and mortality were assessed by regression analyses. Kaplan-Meier estimates were applied to examine survival times. Results: There were 360 patients enrolled, the incidence of CIP was 8.6% (31/360). Of all CIP, 12 were graded 3 or higher based on the Common Terminology Criteria for Adverse Events (CTCAE 5.0). The median time to CIP onset was 90 (interquartile range [IQR], 37–160) days. A significant association for CIP was found with body mass index (BMI) (p=0.004) and chronic obstructive pulmonary disease (COPD) (p=0.003) on univariate and multivariate logistic regression analyses. In patients who developed CIP and those who did not, the progression free survival and overall survival were not statistically different. Additionally, early-onset CIP had a higher risk of mortality (p=0.039, HR=3.677, 95% CI, 1.071-12.554), after adjusting for sex, age and rechallenge. Conclusion: Increased BMI and COPD were strongly associated with CIP. Early-onset CIP significantly increased the risk of mortality.