WCLC 2025 - Posters & ePosters-P1.11.51 Effects of Immune Checkpoint Inhibitors on the Pulmonary Circulation in Lung Cancer Patients

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This retrospective cohort study evaluated the impact of immune checkpoint inhibitors (ICIs) on pulmonary circulation in 461 lung cancer patients over two years. ICIs, while transforming cancer treatment, can induce immune-related adverse events (irAEs) such as pulmonary circulation injury, notably immune-related pulmonary hypertension (irPAH). The study analyzed pulmonary artery diameter (PAD), aortic diameter (AoD), and their ratio (PAD/AoD) via chest CT scans at baseline, 3, 6, 12, and 24 months post-ICI treatment. Results showed a significant increase in PAD (from 25.19 mm to 26.33 mm) and PAD/AoD ratio (from 0.70 to 0.73) within the first three months of therapy (p < 0.001), indicating early pulmonary vascular involvement. Additionally, elevations in myocardial injury biomarkers—including high-sensitivity troponin I (hs-TnI), α-hydroxybutyrate dehydrogenase, creatine kinase, and related enzymes—were observed (p < 0.05), though cardiac ultrasound parameters remained stable.<br /><br />Survival analysis distinguished a "severe" group with marked PAD/AoD progression, revealing significantly reduced overall survival (43 vs. 56 months, p=0.008) and progression-free survival (15 vs. 20 months, p < 0.001) compared to the non-severe group. PAD/AoD ratio progression emerged as an independent prognostic indicator. Notably, immune-related pneumonia (CIP) did not significantly affect PAD/AoD ratio changes (p=0.999), underscoring that pulmonary vascular injury is a distinct ICI-related complication.<br /><br />The study recommends routine monitoring of the PAD/AoD ratio through chest CT and surveillance of hs-TnI and cardiac enzymes in lung cancer patients receiving ICI therapy. This approach allows early detection of pulmonary circulation injury, aiding in distinguishing patients likely to benefit from ICIs versus those who may need alternative treatments. Overall, findings highlight the importance of vigilant cardiopulmonary assessment during ICI therapy to optimize outcomes in lung cancer management.

Asset Subtitle

Xia Yang

Meta Tag

Speaker Xia Yang

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

immune checkpoint inhibitors

lung cancer

pulmonary circulation injury

immune-related pulmonary hypertension

pulmonary artery diameter

PAD/AoD ratio

myocardial injury biomarkers

overall survival

progression-free survival

cardiopulmonary monitoring