Study Finds Pneumonitis Associated With Anti–PD-1/PD-L1 Antibody Treatment


Key Points

  • The overall incidence of pneumonitis was 5% in patients receiving anti–PD-1/PD-L1 monoclonal antibody as monotherapy or combined with anticytotoxic T-cell lymphocyte 4 monoclonal antibody treatment.
  • The incidence of pneumonitis was 10% with combination immunotherapy and 3% with anti–PD-1/PD-L1 monotherapy.

In a two-institution experience reported in the Journal of Clinical Oncology, Naidoo et al identified the incidence of pneumonitis occurring in patients receiving anti–PD-1/PD-L1 (programmed cell death protein 1/ligand 1) monoclonal antibody as monotherapy or combined with anticytotoxic T-cell lymphocyte 4 monoclonal antibody treatment.

Study Details

The study involved 915 patients receiving anti–PD-1/PD-L1 monoclonal antibodies, including 578 for advanced solid cancers between 2009 and 2014 at Memorial Sloan Kettering Cancer Center and 337 for melanoma only between 2013 and 2015 at the Melanoma Institute of Australia.

Incidence of Pneumonitis

Among all 915 patients, pneumonitis developed in 43 (5%), including 27 (5%) of patients at Memorial Sloan Kettering Cancer Center and 5% at Melanoma Institute of Australia. Time to onset ranged from 9 days to 19.2 months, and radiologic and pathologic features were diverse. Pneumonitis occurred in 19 (10%) of 199 patients receiving combination immunotherapy vs 24 (3%) of 716 receiving monotherapy (P < .01). Pneumonitis occurred in 26 (5%) of 532 patients with melanoma and 9 (4%) of 209 with non–small cell lung cancer, including 15 (4%) of 417 and 5 (3%) of 152 receiving monotherapy and 11 (10%) of 115 and 4 (7%) of 57 receiving combination therapy.

Overall, 31 (72%) of 43 cases were grade 1 to 2, and 37 (86%) improved or resolved with drug holding or immunosuppression. Five patients had clinical worsening and died during pneumonitis treatment, with the proximal causes of death being pneumonitis (n = 1), infection related to immunosuppression (n = 3), and progressive cancer (n = 1).

The investigators concluded: “Pneumonitis associated with anti–PD-1/PD-L1 [monoclonal antibodies] is a toxicity of variable onset and clinical, radiologic, and pathologic appearances. It is more common when anti–PD-1/PD-L1 [monoclonal antibodies] are combined with anti–cytotoxic T-cell lymphocyte-4 [monoclonal antibodie]. Most events are low grade and improve/resolve with drug holding/immunosuppression. Rarely, pneumonitis worsens despite immunosuppression, and may result in infection and/or death.”

The study was supported by a grant from Memorial Sloan Kettering Cancer Center.

Matthew D. Hellmann, MD, of Memorial Sloan Kettering Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.