WCLC 2025 - Posters & ePosters-P1.11.06 Risk Factors and Prognosis of Immune Checkpoint Inhibitor-Induced Pneumonia in Lung Cancer With Interstitial Lung Disease

P1.11.06 Risk Factors and Prognosis of Immune Checkpoint Inhibitor-Induced Pneumonia in Lung Cancer With Interstitial Lung Disease

Back to course

Pdf Summary

This study investigated risk factors and prognosis of immune checkpoint inhibitor (ICI)-induced pneumonitis in lung cancer patients with interstitial lung disease (ILD). Lung cancer patients with ILD have higher rates of ICI-induced pneumonitis, and are often excluded from clinical trials. However, ICIs may be feasible in mild ILD cases without lung function decline, usual interstitial pneumonia (UIP) patterns, or high antinuclear antibody levels.<br /><br />The retrospective analysis included 22 lung cancer patients with ILD treated with ICIs from 2016 to 2024. Seven developed ICI-induced pneumonitis, while 15 did not. Clinical variables, including FDG uptake in lung lesions measured by PET scan, were compared. The maximum standardized uptake value (SUVmax) and standardized uptake value ratio (SUVR) of interstitial lesions were evaluated as potential risk factors.<br /><br />Results showed significantly higher SUVmax (2.0 vs. 1.3, p=0.03) and SUVR (0.9 vs. 0.6, p=0.038) in patients with pneumonitis. ROC curve analysis indicated SUVR cutoff of 0.8268 predicted pneumonitis with 86% sensitivity and specificity. Logistic regression revealed SUVR above this cutoff was significantly associated with higher pneumonitis risk (odds ratio 15, p=0.02). Other factors like age, gender, ILD pattern, and serologic markers were not statistically significant predictors.<br /><br />The study suggests that in addition to established clinical criteria (HAV criteria: honeycomb lung, autoantibodies, lung function decline), SUVR on PET imaging may be a useful biomarker for assessing pneumonitis risk in ILD patients receiving ICI therapy. Notably, some pneumonitis cases occurred even with low SUVmax values when treated with combined PD-1 and CTLA-4 inhibitors, indicating multiple factors influence risk.<br /><br />In conclusion, SUVR measured by FDG-PET could serve as an important risk factor for ICI-induced pneumonitis in lung cancer patients with ILD, aiding in patient selection and management to optimize immunotherapy benefits while minimizing pulmonary toxicity.

Asset Subtitle

Tsukasa Ueda

Meta Tag

Speaker Tsukasa Ueda

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

immune checkpoint inhibitor

ICI-induced pneumonitis

lung cancer

interstitial lung disease

ILD

FDG-PET imaging

standardized uptake value ratio

SUVR cutoff

risk factors

immunotherapy toxicity