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Risk Factors for Pneumonitis in Patients with Unresectable Advanced Non-small Cell Lung Cancer Treated with Immune
Taisuke Isono1, Akihiro Ishida1, Yoko Onodera1
1Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan.
Internal Medicine (Tokyo, Japan)
|March 26, 2026
Summary
Pre-existing idiopathic interstitial pneumonia (IIP) increases the risk of pneumonitis during immune checkpoint inhibitor (ICI) therapy for non-small cell lung cancer. Careful baseline lung evaluation, especially for IIP, is crucial before starting ICI treatment.
Area of Science:
- Oncology
- Pulmonology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are vital cancer treatments but can cause immune-related adverse events (irAEs).
- Pneumonitis is a serious irAE, and its predictive factors in non-small cell lung cancer (NSCLC) patients undergoing ICI therapy require clarification.
Purpose of the Study:
- To identify predictive factors for pneumonitis in unresectable advanced NSCLC patients receiving ICI therapy.
Main Methods:
- Retrospective analysis of 403 NSCLC patients treated with ICIs from January 2016 to January 2024.
- Multivariate Fine-Gray analysis to assess the association of pre-existing pulmonary conditions with pneumonitis.
Main Results:
- Pneumonitis occurred in 15.9% of patients; grade ≥3 pneumonitis in 3.2%.
- Higher pneumonitis incidence was observed in patients with pre-existing pulmonary disease, particularly idiopathic interstitial pneumonia (IIP).
- Pre-existing IIP was independently associated with pneumonitis; honeycomb lung was not a significant factor.
Conclusions:
- Pre-existing IIP is an independent risk factor for pneumonitis during ICI therapy.
- Baseline evaluation of lung involvement, especially IIP, is essential before initiating ICI treatment in NSCLC patients.
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