Cancers (Dec 2022)

Impact of Infections in Patients Receiving Pembrolizumab-Based Therapies for Non-Small Cell Lung Cancer

  • Ethan A. Burns,
  • Kelly Gee,
  • Ryan B. Kieser,
  • Jiaqiong Xu,
  • Yuqi Zhang,
  • Aubrey Crenshaw,
  • Ibrahim N. Muhsen,
  • Charisma Mylavarapu,
  • Abdullah Esmail,
  • Shivan Shah,
  • Godsfavour Umoru,
  • Kai Sun,
  • Carlo Guerrero,
  • Zimu Gong,
  • Kirk Heyne,
  • Monisha Singh,
  • Jun Zhang,
  • Eric H. Bernicker,
  • Maen Abdelrahim

DOI
https://doi.org/10.3390/cancers15010081
Journal volume & issue
Vol. 15, no. 1
p. 81

Abstract

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Background: Immune checkpoint inhibitor (ICI) therapy has significantly improved outcomes across a range of malignancies. While infections are a well-known contributor to morbidity and mortality amongst patients receiving systemic chemotherapy regimens, little is known about the impact of infections on patients receiving ICI therapy. This study aims to assess incidence, risk factors, and outcomes in patients who develop infections while on pembrolizumab-based therapies for non-small cell lung cancer (NSCLC). Methods: Patients receiving pembrolizumab for stage III/IV NSCLC from 1/1/2017-8/1/2021 across seven hospitals were identified. Incidence and type of infection were characterized. Covariates including baseline demographics, treatment information, treatment toxicities, and immunosuppressive use were collected and compared between infected and non-infected patients. Outcomes included the rate of infections, all-cause hospital admissions, median number of treatment cycles, overall survival (OS), and progression free survival (PFS). Univariable and multivariable analysis with reported odds ratio (OR) and 95% confidence intervals (CI) were utilized to evaluate infection risks. OS and PFS were analyzed by Kaplan–Meier analysis and tested by log-rank test. p-value p = 0.016], hospital [87 (78.4%) vs. 53 (40.1%), p p p = 0.033). On multivariable analysis, anti-infective therapy (OR 3.32, [95% CI: 1.26–8.76], p = 0.015) and ECOG of >1 (OR 5.79, [95% CI 1.72–19.47], p = 0.005) at ICI initiation conferred an increased risk for infections. At last evaluation, 74 (66.7%) infected and 70 (53.0%) non-infected patients died (p = 0.041). Conclusion: Infections occurred in nearly half of patients receiving pembrolizumab-based therapies for NSCLC. Infected patients had frequent hospitalizations, treatment delays, and poorer survival. ECOG status and anti-infective use at ICI initiation conferred a higher infection risk. Infection prevention and control strategies are needed to ameliorate the risk for infections in patients receiving ICIs.

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