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Shinsuke Murakami



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    EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.16-38 - Pulmonary Infiltrates in Patients Treated with Anti-Programmed Death-1/Programmed Death Ligand 1 Therapy (Now Available) (ID 1654)

      08:00 - 18:00  |  Author(s): Shinsuke Murakami

      • Abstract
      • Slides

      Background

      Interstitial lung disease (ILD) is one of the fatal toxicities of anti-programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1) monoclonal antibodies (mAbs). Some possible risk factors are indicated like male, smoker, and previous history of interstitial pneumonia, but clinical, and radiologic features are not well known.

      Method

      Patients who received anti-PD-1/PD-L1 monotherapy were identified at our hospital from March 2016 to October 2018. We identified the patients who developed pulmonary infiltrates after PD-1/PD-L1 therapy, cases with confirmed malignant lung infiltration were excluded. We retrospectively analyzed their clinical and radiological features.

      Result

      Of 77 patients who received anti-PD-1/PD-L1 mAbs, pulmonary infiltrates developed in 10. The clinical and radiologic features are shown in Table1,2.

      Table.1 Baseline characteristics of 10 patients with pulmonary infiltrates related to immune checkpoint inhibitors.
      Pt Sex Age Histology Smoking status Smoking
      (pack-years)
      Stage Primary site Performance status Prior chemotherapy Radiation history
      to the Chest
      TPS
      (22c3)
      Agents
      1 M 73 Adeno Former 45 Right upper lobe 0 None None 100 Pembrolizumab
      2 M 74 Adeno Former 80 Reccurent Right lower lobe 1 None None 95 Pembrolizumab
      3 M 71 Squamous Current 85.5 Right lower lobe 1 None None 70 Pembrolizumab
      4 M 84 Adeno Current 48 ⅢC Left lower lobe 1 None None 65 Pembrolizumab
      5 M 71 Squamous Former 46 Right upper lobe 1 Carboplatin/nab-Paclitaxel
      Docetaxel
      None 30 Pembrolizumab
      6 M 70 Squamous Former 80 Left upper lobe 0 Carboplatin/nab-Paclitaxel
      Carboplatin/S1
      None NA Nivolumab
      7 M 61 Adeno Former 28 ⅢB Left upper lobe 1 Carboplatin/Paclitaxel
      Docetaxel
      Carboplatin/Pemetrexed
      Carboplatin/nab-Paclitaxel
      60Gy NA Nivolumab
      8 M 61 Adeno Former 37 Right pleural 0 Carboplatin/Paclitaxel
      Carboplatin/Pemetrexed
      Docetaxel
      Carboplatin/S-1
      None NA Nivolumab
      9 M 58 Squamous Former 54 Left upper lobe 2 Carboplatin/Paclitaxel 70Gy NA Nivolumab
      10 M 81 Squamous Former 59 Right upper lobe 2 Docetaxel
      Carboplatin/S-1
      nab-Paclitaxel
      None NA

      Nivolumab

      Table.2 Occurrence with pulmonary infiltrates related to immune checkpoint inhibitors.
      Pt Radiographic
      patterm
      Grade Distribution Time to event onset, days KL-6, U/ml CRP at
      onset, mg/dl
      Treatment Time from treatment to resolution/ resolving, days Outcome
      at Baseline at Event onset
      1 DAD 4 Bilateral/Diffuse 151 493 4348 25.2 Steroid pulse therapy
      Antibiotics
      64 Resolving
      2 OP 5 Bilateral/Diffuse 9 368 948 25.2 Steroid pulse therapy
      Antibiotics
      Not resolved Not resolved
      3 OP 2 Bilateral/Focal 63 340 1591 1.1 Oral steroids
      Antibiotics
      9 Resolved
      4 NSIP 2 Bilateral/Diffuse 71 407 489 12.2 Antibiotics
      →Oral steroids
      60 Resolved
      5 NSIP 3 Bilateral/Diffuse 17 724 1266 9.9 Steroid pulse therapy 7 Resolved
      6 OP 3 Bilateral/Diffuse 291 254 1182 0.3 Steroid pulse therapy Not resolved Not resolved
      7 NSIP 1 Unilateral/Focal 251 256 189 0.2 None 24 Resolved
      8 OP 2 Unilateral/Diffuse 70 N/A 300 2.3 Steroid pulse therapy 69 Resolved
      9 NSIP 3 Bilateral/Diffuse 402 N/A N/A 7.3 Steroid pulse therapy
      Oxygen therapy
      Antibiotics
      18 Resolving
      10 OP 1 Unilateral/Focal 56 1078 1257 1.0 None 31 Resolved
      Conclusion

      Pulmonary infiltrates associated with anti-PD-1/PD-L1 mAbs showed variable onset and clinical, and radiologic appearances. Sometimes it is difficult to identify whether it is ILD or infection. Most ILD cases were successfully treated with corticosteroids, but rarely, ILD worsened despite treatment. Thus, careful monitoring including imaging examinations is important to preventing the worsening of ILD.

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