Related Experiment Video
Updated: Dec 29, 2025
Using 22C3 Anti-PD-L1 Antibody Concentrate on Biopsy and Cytology Samples from Non-small Cell Lung Cancer Patients
Published on: September 25, 2018
PD-1 inhibitors for non-small cell lung cancer patients with special issues: Real-world evidence
Seonggyu Byeon1, Jang Ho Cho2, Hyun Ae Jung1
1Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Background:
Immune checkpoint inhibitors (ICIs) have provided new therapeutic options for non-small cell lung cancer(NSCLC) patients. However, due to concerning increases in immune-related adverse events, clinical trials usually exclude patients with special issues such as viral hepatitis, tuberculosis (Tbc), interstitial lung disease (ILD) and autoimmune disease.
Methods:
We retrospectively reviewed the medical records of NSCLC patients who received ICIs, and analyzed the clinical outcomes of patients with special issues.
Results:
Between January 2015 and October 2018, 237 patients received ICIs. Of these patients, 26% (61/237) had special issues: 32 had hepatitis B viral (HBV) infections, 20 Tbc, six ILD, one HIV infection, one Behçet's disease and a past HBV infection, and one rheumatoid arthritis. The incidence of hepatitis tended to be higher in patients with HBV infections than in those without (18.8% vs 8.91%, P = .082). Severe hepatitis (grade 3 or higher) was more common in HBV-infected patients (12.5% vs 1.9%, P = .0021), but the AEs were well-managed. During ICI treatment, three of the 20 patients with a history of pulmonary Tbc developed active pulmonary Tbc, considered reactivations. No aggravation of ILD was noted. One RA patient experienced a disease flare and was treated with a low-dose steroid. There was no significant difference in the overall response rate or progression-free survival between patients with and without special issues.
Conclusion:
Given the relatively low incidence of immune-related AEs and the comparability of clinical outcomes, ICIs can be treatment option of NSCLC patients with special issues.
Insights
Immune checkpoint inhibitors (ICIs) are viable for non-small cell lung cancer (NSCLC) patients with conditions like viral hepatitis or tuberculosis. Outcomes were comparable to patients without these issues, with manageable adverse events.
Area of Science:
- Oncology
- Immunotherapy
- Pulmonology
Background:
- Immune checkpoint inhibitors (ICIs) offer new treatment avenues for non-small cell lung cancer (NSCLC).
- Clinical trials often exclude patients with comorbidities like viral hepatitis, tuberculosis (Tbc), interstitial lung disease (ILD), and autoimmune diseases due to safety concerns.
- These exclusions limit understanding of ICI efficacy and safety in diverse NSCLC patient populations.
Purpose of the Study:
- To evaluate the clinical outcomes and safety of immune checkpoint inhibitors (ICIs) in NSCLC patients with pre-existing special conditions.
- To compare the efficacy and adverse event profiles of ICIs in NSCLC patients with and without conditions such as viral hepatitis, Tbc, ILD, and autoimmune diseases.
Main Methods:
- Retrospective review of medical records for 237 NSCLC patients treated with ICIs between January 2015 and October 2018.
- Analysis of clinical outcomes, including overall response rate and progression-free survival.
- Assessment of immune-related adverse events (AEs), focusing on hepatitis, Tbc reactivation, ILD exacerbation, and autoimmune disease flares.
Main Results:
- 26% of patients had special issues, including hepatitis B virus (HBV) infection (32), Tbc (20), ILD (6), and autoimmune diseases (2).
- Severe hepatitis (grade 3+) was more frequent in HBV-infected patients (12.5% vs 1.9%), but AEs were manageable.
- Tbc reactivation occurred in 3/20 patients; no ILD aggravation was observed; one rheumatoid arthritis patient experienced a flare.
- No significant differences in overall response rate or progression-free survival were found between patients with and without special issues.
Conclusions:
- Immune checkpoint inhibitors (ICIs) can be a safe and effective treatment option for NSCLC patients with special issues.
- The incidence of severe immune-related adverse events is relatively low and manageable in this population.
- Comparable clinical outcomes support the use of ICIs in NSCLC patients with comorbidities, broadening therapeutic options.
Related Concept Videos
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
01:28Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...