Pretreatment Lung Function and Checkpoint Inhibitor Pneumonitis in NSCLC

Joshua E. Reuss, MD; Emily Brigham, MD, MHS; Kevin J. Psoter, PhD; Khinh Ranh Voong, MD; Bairavi Shankar, BS; David S. Ettinger, MD; Kristen A. Marrone, MD; Christine L. Hann, MD; Benjamin Levy, MD; Josephine L. Feliciano, MD; Julie R. Brahmer, MD; David Feller-Kopman, MD; Andrew D. Lerner, MD; Hans Lee, MD; Lonny Yarmus, DO; Russell K. Hales, MD; Franco D’Alessio, MD; Sonye K. Danoff, MD, PhD; Patrick M. Forde, MBBCH; Karthik Suresh, MD; Jarushka Naidoo, MBBCH, MHS

JTO Clinical and Research Reports (Oct 2021)

Pretreatment Lung Function and Checkpoint Inhibitor Pneumonitis in NSCLC

Joshua E. Reuss, MD,
Emily Brigham, MD, MHS,
Kevin J. Psoter, PhD,
Khinh Ranh Voong, MD,
Bairavi Shankar, BS,
David S. Ettinger, MD,
Kristen A. Marrone, MD,
Christine L. Hann, MD,
Benjamin Levy, MD,
Josephine L. Feliciano, MD,
Julie R. Brahmer, MD,
David Feller-Kopman, MD,
Andrew D. Lerner, MD,
Hans Lee, MD,
Lonny Yarmus, DO,
Russell K. Hales, MD,
Franco D’Alessio, MD,
Sonye K. Danoff, MD, PhD,
Patrick M. Forde, MBBCH,
Karthik Suresh, MD,
Jarushka Naidoo, MBBCH, MHS

Affiliations

Joshua E. Reuss, MD: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland; Corresponding author. Address for correspondence: Joshua E. Reuss, MD, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
Emily Brigham, MD, MHS: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Kevin J. Psoter, PhD: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Khinh Ranh Voong, MD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Bairavi Shankar, BS: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
David S. Ettinger, MD: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Kristen A. Marrone, MD: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland
Christine L. Hann, MD: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland
Benjamin Levy, MD: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland
Josephine L. Feliciano, MD: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland
Julie R. Brahmer, MD: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland
David Feller-Kopman, MD: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Andrew D. Lerner, MD: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Hans Lee, MD: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Lonny Yarmus, DO: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Russell K. Hales, MD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Franco D’Alessio, MD: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sonye K. Danoff, MD, PhD: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Patrick M. Forde, MBBCH: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland
Karthik Suresh, MD: Division of Pulmonary Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Jarushka Naidoo, MBBCH, MHS: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, Maryland

Journal volume & issue: Vol. 2, no. 10
p. 100220

Abstract

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Introduction: Checkpoint inhibitor pneumonitis (CIP) is a serious toxicity of anti–programmed death-(ligand) 1 immunotherapy. Whether pretreatment differences in pulmonary function exist in patients who develop CIP is unknown. We analyzed the pulmonary function tests (PFTs) of patients with NSCLC treated with immune checkpoint inhibitors (ICIs) to evaluate whether pretreatment lung function was associated with CIP development. Methods: Patients were included if they completed greater than or equal to 1 PFT within 2 years preceding ICI initiation. CIP status (CIP+: developed CIP, CIP−: did not develop CIP) was determined clinically. Generalized estimating equation–based linear regression was used to evaluate the effects of time and CIP on lung function. Primary outcomes included the following: percent-predicted forced expiratory volume in 1 second (FEV1pp), percent-predicted forced vital capacity (FVCpp), and FEV1/FVC. Results: A total of 43 patients (34 CIP−, 9 CIP+) with 79 PFTs (59 CIP−, 20 CIP+) were included. CIP+ patients had a 21.7% lower pretreatment FEV1pp compared with the CIP− group (95% confidence interval: −38.6 to −4.7). No statistically significant differences in FVCpp or FEV1/FVC were observed. The prevalence of obstructive lung disease was similar in both groups at 67% and 62% for the CIP+ and CIP− cohorts, as was the prevalence of current/former smoking at 100% and 93%, respectively. Conclusions: Pretherapy differences in lung function were evident between patients who did and did not develop CIP, though the prevalence of obstructive lung disease was similar. Prospective studies are needed to validate these findings, inform potential risk factors for CIP, and investigate the effects of ICI treatment and CIP on pulmonary function in patients with NSCLC.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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