Past medical history of pneumonitis linked with increased risk of cancer treatment-associated pneumonitis

New research demonstrates that amongst individuals with advanced non-small-cell lung cancer and past medical history of pneumonitis, incidence of cancer treatment-associated pneumonitis was greater compared with individuals without past pneumonitis medical histories.

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New research suggests that individuals with advanced non-small-cell lung cancer who have past medical histories of pneumonitis face increased risks of developing recurrent pneumonitis associated with immune checkpoint inhibitor or chemotherapy administration. The data were presented during a virtual plenary session on lung cancer targeted therapy at the American Association for Cancer Research (AACR) Virtual Annual Meeting I (27–28 April 2020).

Pneumonitis – inflammation of lung tissue – can be an acutely life-threatening adverse event associated with administration of certain common anti-cancer drugs, such as immune checkpoint inhibitors.

In this new study, conducted by investigators from the US FDA, Syapse (CA, USA) and Advocate Aurora Health (WI, USA), incidence rates of pneumonitis amongst more than 7500 individuals – identified from both clinical trial and real-world data – with advanced non-small-cell lung cancer receiving immune checkpoint inhibitors or chemotherapies were compared. 

A total of 6491 individuals with who participated in eight clinical trials directly comparing immune checkpoint inhibitors with chemotherapies were included in the study. The real-world data analyzed in the study pertained to a further 1262 individuals, identified from a single community health system.

Study participants were categorized into four subgroups defined by their past medical histories of pneumonitis and whether hey had been treated with immune checkpoint inhibitors (with or without concurrent chemotherapy) or chemotherapies only.

Similar rates of treatment-associated pneumonitis were observed across both the clinical trial and real-world datasets. Researchers observed greater incidences of treatment-associated pneumonitis amongst individuals who had past medical histories of pneumonitis compared with those who had never had the condition, regardless of treatment type.

Only when considering clinical trial data pertaining to individuals with no previous medical history of pneumonitis did investigators observe a difference in treatment-associated pneumonitis incidence between immune checkpoint inhibitor-receiving and chemotherapy-receiving groups.

Further analysis of the real-world data suggests that pneumonitis incidence is strongly related to radiotherapy provision, when administered in combination with either immune checkpoint inhibitors or chemotherapy; 73% of all pneumonitis diagnoses resulted from radiotherapy.

Michael Thompson, Medical Director of the Early Phase Cancer Research Program at Advocate Aurora Health, commented: "Clinicians and regulators are interested in real-world safety profiles to develop new practices for managing risk and evaluating potentially beneficial therapies when comorbidities such as pneumonitis are present. This research provides encouraging new data that clinicians can use to better understand the post-approval behavior of drugs in the real world."

The study authors conclude that further research is warranted in order to optimize treatment for cancer patients with past medical histories of pneumonitis.


Sources:

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. The American Association for Cancer Research Virtual Annual Meeting I (27–28 April). Session number: VCTPL08; www.syapse.com/news/press-releases/aacr-2020-pneumonitis

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