Are Immune Checkpoint Inhibitors Safe and Effective in Lung Cancer Patients with Pre-Existing Interstitial Lung Disease?

Abstract

Aim: This study aims to clarify the efficacy and adverse effects of immune checkpoint inhibitors (ICIs) in the lung cancer patients with a history of interstitial lung disease (ILD). Methods: From the inception of the database to 4 April 2023, we systematically searched the four databases. Results: The objective remission rate, disease control rate, incidence of immune-associated pneumonitis (ICIP) in the combined ILD group were significantly higher than those in the non-combined ILD group. There were no significant differences between the two groups in progression-free survival, overall survival, renal insufficiency, thyroid dysfunction and gastrointestinal toxicity. Conclusion: Generally, a pre-existing ILD history can increase the efficacy and incidence of ICIs’ adverse reactions. Therefore, ICIs should be administered with caution.

Plain language summary

Immune checkpoint inhibitors are a type of immunotherapy used to treat lung cancer. Some experts disagree over whether it is safe and effective to use this type of immunotherapy in people with lung cancer who also have lung disease. In this paper, the researchers analyzed the results of lots of different studies relating to the use of immune checkpoint inhibitors to treat lung cancer in patients with and without lung disease. They wanted to find out whether immune checkpoint inhibitors differed in their effectiveness between the two groups of patients. They also looked at whether patients with lung disease experienced more negative side effects from the immunotherapy treatment.

The researchers found that patients with lung disease had a bigger response to immune checkpoint inhibitor treatment than patients without lung disease. This means that this type of immunotherapy is likely to be effective at treating lung cancer in patients with lung disease. However, the researchers also found that this patient group was more likely to experience negative side effects from the immunotherapy treatment. In particular, there were many more cases of pneumonia in this group than in the patients without lung disease. Therefore, doctors should be cautious when using immunotherapy to treat lung cancer patients with lung disease, ensuring they take measures to prevent pneumonia and be better prepared in case negative side effects occur.

Keywords: :

• adverse effects
• efficacy
• immunocheckpoint inhibitors
• interstitial lung disease
• lung cancer
• meta analysis

Supplementary data

To view the supplementary data that accompany this paper, please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/imt-2023-0147

Author contributions

L Zhu and H Li conducted literature retrieval, data extraction and literature quality evaluation. L Zhu performed statistical analysis and wrote the original manuscript. JL Yang revised the manuscript and corrected some of the information in tables and Figures. Z Yahui resolved differences in literature retrieval and data processing. R Gao provided suggestions for what to write and critically revised the manuscript.

Financial disclosure

Fund Project: National Key Research and Development Program (2021YFC2500700). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Data sharing statement

Availability of data, code, and other materials: The datasets supporting the conclusions of this article are included within the article and its additional files.