2023 World Conference on Lung Cancer (Posters)-P2.02. Pneumonitis Rates Before Versus After Adoption of Immunotherapy Consolidation for Locally Advanced Non-Small Cell Lung Cancer

P2.02. Pneumonitis Rates Before Versus After Adoption of Immunotherapy Consolidation for Locally Advanced Non-Small Cell Lung Cancer - PDF(Abstract)

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The study presented at the WCLC 2023 conference aimed to investigate the rates and predictors of pneumonitis before and after the adoption of immunotherapy consolidation for locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with concurrent chemoradiotherapy (cCRT). The study included 783 patients from a single institution, divided into two cohorts: the pre-ICI era (January 2011 to September 2017) and the ICI era (October 2017 to December 2021).<br /><br />The results showed that the adoption of consolidation immune checkpoint inhibitors (ICIs) was associated with an 11% increase in the risk of symptomatic pneumonitis, specifically grade 2 events. The rates of grade 2 pneumonitis were significantly higher in the ICI era cohort compared to the pre-ICI era cohort. On multivariable analysis, predictors of grade 2 pneumonitis included the ICI era treatment, higher lung V20 (volume receiving 20 Gy), and smaller lung volume. The lung dose cutpoints to predict for grade 2 pneumonitis were lower in the ICI era compared to the pre-ICI era. Therefore, the study suggests that stricter radiation therapy lung dose constraints may be necessary when integrating ICIs with cCRT to minimize the risk of pneumonitis.<br /><br />However, the rates of grade 3 pneumonitis did not significantly differ between the two cohorts. Predictors of grade 3 pneumonitis were higher lung V20 and pulmonary comorbidity, but not the ICI era treatment.<br /><br />In conclusion, the adoption of consolidation ICIs in the treatment of LA-NSCLC patients treated with cCRT was associated with an increased risk of symptomatic pneumonitis, driven by an increase in grade 2 events. The study highlights the importance of considering lung dose constraints when using ICIs in combination with cCRT to reduce the risk of pneumonitis.

Asset Subtitle

Nikhil Yegya-Raman

Meta Tag

Speaker Nikhil Yegya-Raman

Topic Local-Regional NSCLC: Toxicities of Multimodality Therapy

Keywords

pneumonitis

immunotherapy consolidation

non-small cell lung cancer

chemoradiotherapy

ICI era

symptomatic pneumonitis

grade 2 events

lung V20

lung volume

radiation therapy lung dose constraints