Immune checkpoint inhibitor-related risk of pulmonary AEs

Excerpt

Immune checkpoint inhibitors (ICIs) increase the risk of pulmonary adverse events (PAEs), according to findings of a systematic review and network meta-analysis published in BMC Medicine .CINAHL, Cochrane Library, Embase, PubMed, PsycINFO, Web of Science and Scopus databases, and clinical trial websites, were searched from 2011 to April 2023 for phase II and III randomised clinical trials and single-arm trials in which at least one treatment group received ICI treatment, including programmed cell death-1 receptor antagonists (PD-1 inhibitors), programmed cell death-1 ligand-1 (PDL1) inhibitors and/or cytotoxic T-lymphocyte antigen-4 (CTLA4) inhibitors, and data on PAEs including interstitial lung diseases and pneumonitis were reported. Bayesian network meta-analysis was used to compare the risk of PAEs between drug classes. In total, 167 studies in 83 191 patients were included in the meta-analysis.Overall, all-grade PAEs were reported in 2.81% of patients, grade 3–4 PAEs were reported in 1.06% and fatal PAEs were reported in 0.13%. The incidence of all-grade PAEs was highest in those receiving triple therapy (5.15%), and was greatest with a PDL1 inhibitor plus CTLA4 inhibitor plus chemotherapy (6.88%).The risks of all-grade PAEs were significantly higher with ICI monotherapy than with chemotherapy and, with the exception of anti-CTLA4 plus chemotherapy, were significantly higher with two ICIs than with ICI plus chemotherapy.Higher dosage regimens were associated with increased risks of ICI-related PAEs in patients receiving nivolumab, atezolizumab or pembrolizumab."In the single-drug regimen, anti-PD1 showed the greatest incidence of PAEs, and the risk of PAEs from single-ICIs was higher than that of chemotherapy, whereas no significant difference was observed in the PAE risk between single-ICIs. In the combined regimen, anti-PD1 plus anti-CTLA4 and plus chemotherapy had the greatest risk of PAEs, but there was no significant difference in the risk between dual-ICIs and single-ICIs," concluded the authors. "Therefore, we recommend a more individualized approach to evaluate the risk of managing PAEs," they commented. …