Clinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective study
Abstract Background Older patients with lung cancer are underrepresented in pivotal trials of immune checkpoint inhibitors (ICIs). This study primarily retrospectively evaluated the older patients with lung cancer treated with ICIs to determine which factors are related to the occurrence and prognos...
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BMC
2025-04-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-05905-w |
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| author | Jiafan Liu Dongmei Zhou Na Wu Jia Liu Xiaonan Wang |
| author_facet | Jiafan Liu Dongmei Zhou Na Wu Jia Liu Xiaonan Wang |
| author_sort | Jiafan Liu |
| collection | DOAJ |
| description | Abstract Background Older patients with lung cancer are underrepresented in pivotal trials of immune checkpoint inhibitors (ICIs). This study primarily retrospectively evaluated the older patients with lung cancer treated with ICIs to determine which factors are related to the occurrence and prognosis of ICI-related pneumonitis (CIP). Methods We conducted a single-center, retrospective study of patients age ≥ 65 years diagnosed with lung cancer who received ICIs between January 2018 and June 2023 at the First Hospital of China Medical University. Clinical characteristics and blood parameters at baseline (before ICIs), at onset of pneumonitis (in the CIP group), and before the last dose of ICIs (in the non-CIP group) were collected and compared. Results A total of 205 older patients with lung cancer were included, of which 51 (24%) patients developed CIP. Radiotherapy history, first line treatment, and the increased baseline systemic immune-inflammation index (SII), and CD4/CD8 were significantly and independently associated with the risk of CIP. Significant increase in CRP and decrease in albumin (ALB), prognostic nutritional index (PNI), and PaO2 were observed from baseline to CIP during treatment with ICIs. The PD-L1 expression status < 50% (P = 0.022) was the risk factor affecting their progression free survival (PFS). ECOG PS ≥ 2 (P = 0.031) and high-CRP (P = 0.007) of older patients were significantly correlated with their overall survival (OS), and patients who experienced CIP had a better OS than non-CIP (P = 0.001). The older patients with interstitial lung abnormalities (ILA) showed a shorter PFS than those without ILA (P = 0.036), and the PD-L1 expression status < 50% (P = 0.005), and low ALB (P = 0.023) was correlated with the OS in CIP. Conclusions Radiotherapy history, first line treatment (mostly in combination therapy), and increased baseline SII and CD4/CD8 were associated with the occurrence of CIP in older patients with lung cancer. PD-L1 expression status < 50%, ECOG PS ≥ 2 and high-CRP were associated with worse prognosis in all older patients. ILA, PD-L1 expression status < 50% and low-ALB at onset of CIP were related to poor prognosis in CIP. |
| format | Article |
| id | doaj-art-a3b1ce2fbf0c41ed9a312b65b5190edc |
| institution | OA Journals |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Geriatrics |
| spelling | doaj-art-a3b1ce2fbf0c41ed9a312b65b5190edc2025-08-20T02:17:49ZengBMCBMC Geriatrics1471-23182025-04-0125112010.1186/s12877-025-05905-wClinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective studyJiafan Liu0Dongmei Zhou1Na Wu2Jia Liu3Xiaonan Wang4Department of Gerontology and Geriatrics, The First Hospital of China Medical UniversityDepartment of Gerontology and Geriatrics, The First Hospital of China Medical UniversityDepartment of Gerontology and Geriatrics, The First Hospital of China Medical UniversityDepartment of Gerontology and Geriatrics, The First Hospital of China Medical UniversityDepartment of Gerontology and Geriatrics, The First Hospital of China Medical UniversityAbstract Background Older patients with lung cancer are underrepresented in pivotal trials of immune checkpoint inhibitors (ICIs). This study primarily retrospectively evaluated the older patients with lung cancer treated with ICIs to determine which factors are related to the occurrence and prognosis of ICI-related pneumonitis (CIP). Methods We conducted a single-center, retrospective study of patients age ≥ 65 years diagnosed with lung cancer who received ICIs between January 2018 and June 2023 at the First Hospital of China Medical University. Clinical characteristics and blood parameters at baseline (before ICIs), at onset of pneumonitis (in the CIP group), and before the last dose of ICIs (in the non-CIP group) were collected and compared. Results A total of 205 older patients with lung cancer were included, of which 51 (24%) patients developed CIP. Radiotherapy history, first line treatment, and the increased baseline systemic immune-inflammation index (SII), and CD4/CD8 were significantly and independently associated with the risk of CIP. Significant increase in CRP and decrease in albumin (ALB), prognostic nutritional index (PNI), and PaO2 were observed from baseline to CIP during treatment with ICIs. The PD-L1 expression status < 50% (P = 0.022) was the risk factor affecting their progression free survival (PFS). ECOG PS ≥ 2 (P = 0.031) and high-CRP (P = 0.007) of older patients were significantly correlated with their overall survival (OS), and patients who experienced CIP had a better OS than non-CIP (P = 0.001). The older patients with interstitial lung abnormalities (ILA) showed a shorter PFS than those without ILA (P = 0.036), and the PD-L1 expression status < 50% (P = 0.005), and low ALB (P = 0.023) was correlated with the OS in CIP. Conclusions Radiotherapy history, first line treatment (mostly in combination therapy), and increased baseline SII and CD4/CD8 were associated with the occurrence of CIP in older patients with lung cancer. PD-L1 expression status < 50%, ECOG PS ≥ 2 and high-CRP were associated with worse prognosis in all older patients. ILA, PD-L1 expression status < 50% and low-ALB at onset of CIP were related to poor prognosis in CIP.https://doi.org/10.1186/s12877-025-05905-wClinical featuresCheckpoint inhibitor-related pneumonitisImmune checkpoint inhibitorsLung cancerOlder patients |
| spellingShingle | Jiafan Liu Dongmei Zhou Na Wu Jia Liu Xiaonan Wang Clinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective study BMC Geriatrics Clinical features Checkpoint inhibitor-related pneumonitis Immune checkpoint inhibitors Lung cancer Older patients |
| title | Clinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective study |
| title_full | Clinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective study |
| title_fullStr | Clinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective study |
| title_full_unstemmed | Clinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective study |
| title_short | Clinical features of immune checkpoint inhibitor-related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors-based therapy: a retrospective study |
| title_sort | clinical features of immune checkpoint inhibitor related pneumonitis in older patients with lung cancer receiving immune checkpoint inhibitors based therapy a retrospective study |
| topic | Clinical features Checkpoint inhibitor-related pneumonitis Immune checkpoint inhibitors Lung cancer Older patients |
| url | https://doi.org/10.1186/s12877-025-05905-w |
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