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CLO24-061: Overall Survival (OS) Impact for NSCLC Patients With irAE and Non-irAE Hospital Admissions During First-Line Pembrolizumab Treatment

Adam Khorasanchi, Songzhu Zhao, Lai Wei, Mingjia Li, Kevin Ho, Hamzah Abu-Sbeih, Evelyn Goodyear, Austin Secor, Peter Shields, Kai He, Jacob Kaufman, Regan Memmott, Asrar Alahmadi, David Carbone, Gregory Otterson, Alexa Meara, Carolyn Presley, and Dwight Owen

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CGE23-070: Baseline Neutrophil to Lymphocyte Ratio and Its Change Over Time Predict Overall Survival in Metastatic Non–Small Cell Lung Cancer Patients Who Received First Line Pembrolizumab Therapy

Kenneth Chian, Mingjia Li, Songzhu Zhao, Saira Farid, Timothy Gauntner, Daniel Spakowicz, Lai Wei, Austin Secor, Evelyn Goodyear, Parthib Das, Kai He, Asrar Alahmadi, Regan Memmott, Jacob Kaufman, Carolyn Presley, Peter Shields, David Carbone, Greg Otterson, and Dwight Owen

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Association Between Pretreatment Chest Imaging and Immune Checkpoint Inhibitor Pneumonitis Among Patients With Lung Cancer

Alexander Wong, Maria Riley, Songzhu Zhao, Jessica Zimmer, Matthew Viveiros, Jing Gennie Wang, Vincent Esguerra, Mingjia Li, Gabrielle Lopez, Kari Kendra, David P. Carbone, Kai He, Asrar Alahmadi, Jacob Kaufman, Regan M. Memmott, Peter G. Shields, Jeremy Brownstein, Karl Haglund, Meng Welliver, Gregory A. Otterson, Carolyn J. Presley, Lai Wei, Dwight H. Owen, and Kevin Ho

Background: Immune checkpoint inhibitors (ICIs) are a first-line and perioperative treatment for lung cancer. Pneumonitis is a potentially life-threatening complication of ICI treatment in 2% to 5% of patients; however, risk factors for developing ICI pneumonitis (ICI-p) remain undefined. Methods: We conducted a retrospective cohort study of consecutive patients with lung cancer who received at least one dose of ICI from 2015 through 2020 at The Ohio State University. Pneumonitis cases were documented by the treating oncologist and retrospectively evaluated for agreement between an oncologist and a pulmonologist. Patient demographic and clinical characteristics were recorded and summarized between those with and without pneumonitis for the overall cohort. Univariate and multivariable survival analyses using the Fine-Gray competing risk model were used to examine the associations. Results: A total of 471 patients with lung cancer were included, of which 402 had non–small cell lung cancer and 69 had small cell lung cancer; 39 (8%) patients in the overall cohort developed ICI-p. Preexisting interstitial abnormalities and prior chest radiation were both significantly associated with ICI-p on univariate analysis (hazard ratio [HR], 8.91; 95% CI, 4.69–16.92; P<.001; and HR, 2.81; 95% CI, 1.50–5.28; P=.001). On multivariable analyses, interstitial abnormalities remained a strong independent risk factor for ICI-p when controlling for chest radiation and type of immunotherapy (HR, 9.77; 95% CI, 5.17–18.46; P<.001). Among patients with ICI-p (n=39), those with severe (grade 3–5) pneumonitis had worse overall survival compared with those with mild (grade 1 or 2) pneumonitis (P=.001). Abnormal pulmonary function test results at both 12 and 18 months prior to ICI initiation were not significantly associated with ICI-p. Conclusions: Preexisting interstitial abnormalities on chest CT and prior chest radiation are independent risk factors that are strongly associated with ICI-p in patients with lung cancer. These findings highlight a potential need for closer observation for ICI-p among patients with these risk factors.