Relationship between pneumonitis induced by immune checkpoint inhibitors and the underlying parenchymal status: a retrospective study.

In patients with primary or secondary lung tumour treated with immune checkpoint inhibitors, immune-related pneumonitis is a rare adverse event but may evolve to respiratory failure. Prompt management is required and usually consists of treatment interruption and immunosuppressive drug administration. The aim of this study was to evaluate relationships between immune-related pneumonitis and pre-existing parenchymal status, especially tumour location and history of chest radiotherapy. Computed tomography (CT) scans of patients with immune-related pneumonitis were retrospectively reviewed. Pattern, distribution and extent of pneumonitis were assessed in six lung regions. In patients who received radiotherapy, the extent of pneumonitis was evaluated according to the radiation field. Among 253 patients treated with immunotherapy, 15 cases of immune-related pneumonitis were identified. 10 had previous or concomitant chest radiotherapy in addition to immunotherapy. At CT scan, 29 (33%) out of 88 regions encompassed the primary tumour (n=4), a lung metastasis (n=4) and/or radiation fields (n=21). A significantly higher prevalence of parenchymal involvement by immune-related pneumonitis occurred within areas of primary or metastatic malignancy and/or radiation field (97%) as compared to other areas (3%, p=0.009). Lung regions affected by the primary tumour, metastasis or radiotherapy had a higher probability of immune-related pneumonitis than others (OR 10.8, p=0.024). An organising pneumonia (OP) pattern was more frequent after radiotherapy (70%

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Conflict of interest: C. Pozzessere has nothing to disclose. Conflict of interest: H. Bouchaab has nothing to disclose. Conflict of interest: R. Jumeau has nothing to disclose. Conflict of interest: I. Letovanec has nothing to disclose. Conflict of interest: C. Daccord has nothing to disclose. Conflict of interest: J. Bourhis has nothing to interest. Conflict of interest: J.O. Prior has nothing to disclose. Conflict of interest: S. Peters reports personal fees for advisory boards and honoraria from Abbvie, Amgen, AstraZeneca, Bayer, Biocartis, Boehringer Ingelheim, Bristol-Myers Squibb, Clovis, Daiichi Sankyo, Debiopharm, Eli Lilly, F. Hoffmann-La Roche, Foundation Medicine, Illumina, Janssen, Merck Sharp and Dohme, Merck Serono, Merrimack, Novartis, Pharma Mar, Pfizer, Regeneron, Sanofi, Seattle Genetics and Takeda; personal fees for talks and honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, F. Hoffmann-La Roche, Merck Sharp and Dohme, Novartis, Pfizer and Takeda; non-financial support for investigation in trials sponsored by Amgen, AstraZeneca, Boehringer Ingelheim, Bristol-Meyers Squibb, Clovis, F. Hoffmann-La Roche, Illumina, Merck Sharp and Dohme, Merck Serono, Novartis and Pfizer; non-financial support for a talk and an honorarium from Sanofi, all outside the submitted work. Conflict of interest: R. Lazor reports personal fees for travel costs for continuing education from Boehringer Ingelheim, Roche and Vifor, outside the submitted work. Conflict of interest: C. Beigelman-Aubry reports personal fees for lectures from Gilead, AstraZeneca and Boehringer, outside the submitted work.