The following article features coverage from the American Association for Cancer Research (AACR) 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Treatment-associated pneumonitis (TAP) was found to occur more frequently among patients with advanced non-small cell lung cancer (NSCLC) with a past history of noninfectious pneumonitis, particularly among patients treated with immune checkpoint inhibition (ICI) vs chemotherapy, according to a retrospective study presented at the 2020 American Association for Cancer Research (AACR) Virtual Annual Meeting I.1

Pneumonitis is known to occur as a result of some anticancer therapies, including immune checkpoint inhibitors (ICIs). The purpose of this study was to understand how past medical history may affect risk for pneumonitis among patients with advanced NSCLC treated with ICI or chemotherapy, using both clinical trial data and real-world data (RWD).

This retrospective study was conducted in collaboration with the US Food and Drug Administration (FDA), Syapse, and Advocate Aurora Health. Clinical trial data were pooled from 8 randomized studies that compared ICI with or without chemotherapy to chemotherapy and identified patients who developed pneumonitis. Patients with advanced NSCLC and pneumonitis were identified using RWD from the Advocate Aurora Health system. Any patient with pneumonitis with infectious etiology was excluded.

Patients with pneumonitis were stratified by 4 subgroups: prior history of noninfectious pneumonitis and treated with ICI or chemotherapy, and patients without a prior history of noninfectious pneumonitis treated with ICI or chemotherapy.


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There were 6491 patients identified from clinical trials and 1262 from RWD. The incidence of pneumonitis was highest among patients with a prior history of noninfectious pneumonitis and who received ICI therapy.

Among patients in the clinical trial dataset, the incidence of pneumonitis in the entire cohort was 4.5% when treated with ICI and 1.0% when treated with chemotherapy. In patients with a prior history of pneumonitis, the incidence was 16.7% and 11.1% when treated with ICI or chemotherapy, respectively. Among patients without a prior history of pneumonitis, 4.4% of patients treated with ICI developed pneumonitis compared with 1% of patients treated with chemotherapy.

Among patients identified in the RWD dataset, the incidence of pneumonitis in the entire cohort was 3.3% with ICI treatment and 2.3% with chemotherapy. In the group with a prior history of pneumonitis, the incidence was 14.3% and 8.3% when treated with ICI or chemotherapy, respectively. For patients without a past history of pneumonitis, the incidence was 2.9% and 2.2%, respectively.

“In the RWD, most patients with prior history of pneumonitis received prior radiation therapy,” Qi Liu, PhD, of the FDA and lead author and presenter of the study, said.

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In conclusion, Dr Liu said that the results show “a higher incidence of TAP incidence among ICI with or without chemotherapy-treated NSCLC patients compared with those receiving chemotherapy alone.” She added that, “while directionally aligned, clinical trial datasets showed stronger signal than RWD sample.”

Dr Liu acknowledged that there were some limitations to the study, including a small numbers of pneumonitis among patients with a past medical history of noninfectious pneumonitis and in the RWD cohorts and that the sample was from a single health system.

For next steps, Dr Liu said that the collaboration plans to “further evaluate potential predictors of pneumonitis and the incidence of TAP for other therapeutic options.” She also said that the group plans to collaborate with other health systems.

Read more of Cancer Therapy Advisor‘s coverage of AACR 2020 meeting by visiting the conference page.

Reference

Liu Q, Zhang C, Gong Y, et al. Pneumonitis incidence in patients with non-small cell lung cancer treated with immunotherapy or chemotherapy in clinical trials and real-world data. Presented at: American Association for Cancer Research (AACR) Virtual Annual Meeting I; April 27-28, 2020. Abstract CT086.