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Treatment patterns and outcomes of high-grade immune checkpoint inhibitor-related pneumonitis in an oncology hospitalist service

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Abstract

Purpose

Immune checkpoint inhibitors (ICI) have become standard of care for some types of lung cancer. Along with expanding usage comes the emergence of immune-related adverse events (irAEs), including ICI-related pneumonitis (ICI-P). Treatment guidelines for managing irAEs have been developed; however, how clinicians manage irAEs in the real-world setting is less well known. We aimed to describe the outcomes and care patterns of grade ≥ 3 ICI-P in an onco-hospitalist service.

Patients and methods

We included patients with lung cancer treated with ICI who were admitted to an oncology hospitalist service with a suspicion of ICI-P. We described the hospitalization characteristics, treatment patterns, discharge practices, and clinical outcomes of patients with confirmed ICI-P. The primary outcome was time to start treatment for ICI-P.

Results

Among 49 patients admitted with a suspicion of ICI-P, 31 patients were confirmed to have ICI-P and subsequently received ICI-P directed treatment. Pulmonology was consulted in 97% of patients. Median time to start treatment for ICI-P was 1 day (IQR 0–3.5 days). All 31 patients received corticosteroids. Inpatient mortality was 32%. Majority of patients discharged with steroids were prescribed prophylaxis for gastritis and opportunistic infections. Thirty-eight percent of patients were seen by pulmonology and 86% were seen by the oncology team post-discharge.

Conclusion

Our study confirms prior findings of high mortality among patients with high-grade ICI-P. Early diagnosis and treatment are key to improving clinical outcomes. Understanding the care patterns and adherence to treatment guidelines of clinicians caring for this patient population may help identify ways to further standardize management practices and improve patient outcomes.

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Funding

Research at The University of Texas MD Anderson Cancer Center is supported by the National Institutes of Health/NCI Cancer Center Support Grant, P30CA016672.

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Authors and Affiliations

  1. Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1465, Houston, TX, 77030, USA

    Joanna-Grace M. Manzano, Hadeel Sahar, Jeffrey Aldrich, Mahran Shoukier, Kodwo Dickson, Kwame Koom-Dadzie, Ed Kheder, Maria C Franco Vega, Alyssa Mohammed, Mayoora Muthu, Cesar Simbaqueba, Michelle Sibille Senechalle & Norman Brito-Dellan

  2. Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Maggie Lu

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christine B. Peterson

  4. Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Jeffrey Aldrich

  5. Oncology Consultants, Houston, TX, USA

    Mahran Shoukier

Authors
  1. Joanna-Grace M. Manzano
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  2. Hadeel Sahar
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  3. Jeffrey Aldrich
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  4. Maggie Lu
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  15. Norman Brito-Dellan
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Contributions

Study concept and design: Joanna-Grace M Manzano MD MPH, Jeffrey Aldrich MD, Maggie Lu PharmD, Mahran Shoukier MD, Norman Brito-Dellan MD.

Data collection: Joanna-Grace M Manzano MD MPH, Hadeel Sahar MD, Jeffrey Aldrich MD, Maggie Lu PharmD, Mahran Shoukier MD, Kodwo Dickson MD, Kwame Koom-Dadzie MD, Ed Kheder MD, Maria Franco-Vega MD, Alyssa Mohammed MD, Mayoora Muthu DO, Cesar Simbaqueba MD, Michelle Sibille Senechalle MD, Norman Brito-Dellan MD.

Data analysis and interpretation: Joanna-Grace M Manzano MD MPH, Hadeel Sahar MD, Jeffrey Aldrich MD, Maggie Lu PharmD, Mahran Shoukier MD, Norman Brito-Dellan MD.

Statistical analysis and interpretation: Christine B Peterson PhD, Joanna-Grace M Manzano MD MPH.

Manuscript preparation and final approval: Joanna-Grace M Manzano MD MPH, Hadeel Sahar MD, Jeffrey Aldrich MD, Maggie Lu PharmD, Mahran Shoukier MD, Christine B Peterson PhD, Kodwo Dickson MD, Kwame Koom-Dadzie MD, Ed Kheder MD, Maria Franco-Vega MD, Alyssa Mohammed MD, Mayoora Muthu DO, Cesar Simbaqueba MD, Michelle Sibille Senechalle MD, Norman Brito-Dellan MD.

Corresponding author

Correspondence to Joanna-Grace M. Manzano.

Ethics declarations

Ethics approval

The Quality Improvement Assessment Board at our institution approved this study. Ethical approval was not required by the reviewing/approving body.

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Not applicable.

Consent for publication

Not applicable. There is no patient identifiable data in this publication.

Competing interests

Maggie Lu has the following declarations outside the submitted work holds stock with Amgen. The authors have no other relevant disclosures.

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Manzano, JG.M., Sahar, H., Aldrich, J. et al. Treatment patterns and outcomes of high-grade immune checkpoint inhibitor-related pneumonitis in an oncology hospitalist service. Support Care Cancer 32, 160 (2024). https://doi.org/10.1007/s00520-024-08361-1

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