Incidence of PD-1 Inhibitor–Related Pneumonitis in Advanced NSCLC, Renal Cell Carcinoma, and Melanoma
In a systematic review and meta-analysis reported in JAMA Oncology, Nishino et al identified the rates of PD-1 (programmed cell death protein 1) inhibitor–related pneumonitis in patients with advanced non–small cell lung cancer (NSCLC), renal cell carcinoma, and melanoma. Rates were higher in patients with NSCLC, renal cell carcinoma, and melanoma receiving combination treatment.
Incidence With Monotherapy
The meta-analysis included 20 studies of NSCLC (5 studies), renal cell carcinoma (3 studies), and melanoma (12 studies) and a total of 4,496 patients.
The overall incidence of pneumonitis during PD-1 inhibitor monotherapy was 2.7% for any grade and 0.8% for grade ≥ 3 pneumonitis. Compared with rates in melanoma patients, rates of any-grade pneumonitis (4.1% vs 1.6%, P = .002) and grade ≥ 3 pneumonitis (1.8% vs 0.2%, P < .001) were higher in NSCLC patients, and the rate of any-grade pneumonitis (4.1% vs 1.6%, P < .001) but not grade ≥ 3 pneumonitis was higher in patients with renal cell carcinoma. Pneumonitis-related deaths occurred in four patients with NSCLC. On multivariate analysis, odds ratios for pneumonitis were 1.43 (P = .005) for any grade and 2.85 (P < .001) for grade ≥ 3 in NSCLC and 1.59 (P < .001) for any grade in renal cell carcinoma compared with melanoma.
Combination Therapy
All studies of combination therapy were in patients with melanoma. Pneumonitis rates were higher with combination therapy vs monotherapy in melanoma for any grade (6.6% vs 1.6%, P < .001) and grade ≥ 3 pneumonitis (1.5% vs 0.2%, P = .001). Pneumonitis-related death occurred in one patient receiving combination therapy. On multivariate analysis, the odds ratios for pneumonitis with combination therapy vs monotherapy were 2.04 (P < .001) for any grade and 2.86 (P < .001) for grade ≥ 3 pneumonitis.
The investigators concluded: “The incidence of PD-1 inhibitor–related pneumonitis was higher in NSCLC and [renal cell carcinoma] and during combination therapy. These findings contribute to enhance awareness among clinicians and support further investigations to meet the clinical needs.”
This study was supported by grants from the National Cancer Institute.
Mizuki Nishino, MD, MPH, of Dana-Farber Cancer Institute, is the corresponding author of the JAMA Oncology article.
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