Infectious Complications in Patients With Non-small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors

Immune checkpoint inhibitors (ICI) have become standard therapy for patients with nonsmall cell lung cancer (NSCLC), however the burden of infectious complications associated with ICI therapy is poorly described. In our single-center cohort of 298 patients with ICI-treated NSCLC, we found that 54.4% of patients experience an infection, and worse infectious outcomes are found in patients with chronic obstructive pulmonary disease, recent corticosteroid use, and concomitant immune-related adverse event and infection. Introduction: Immune checkpoint inhibitors (ICI) are standard treatment for nonsmall cell lung cancer (NSCLC). However, the burden of infectious complications during ICI therapy is poor ly descr ibed. Materials and Methods: We conducted a retrospective study of patients with NSCLC treated with ICIs between 2007 and 2020 at a tertiary academic center. The incidence, characteristics, and healthcare utilization outcomes of infections during ICI therapy and within 3 months of ICI discontinuation are presented using descriptive statistics. Cox proportional hazard models are used to examine infection-free survival by demographic and treatment factors. Associations between patient or treatment characteristics and hospitalization or ICU admission are analyzed by logistic regression, presented as odds ratios (OR). Results: Of 298 patients, infections occurred in 54.4% (n = 162). Of these patients, 59.3% (n = 96) required hospitalization and 15.4% (n = 25) required ICU admission. The most common infection was bacterial pneumonia. Fungal infections occurred in 12 patients (7.4%). Patients with chronic obstructive pulmonary disease (COPD) (OR 2.15, 95% CI, 1.01-4.58), corticosteroid treatment within 1 month prior to infection onset (OR 3.04, 95% CI, 1.47-6.30), and concomitant irAE and infection (OR 5.48, 95% CI, 2.15-14.00) had higher odds of hospitalization. Corticosteroid use was associated with higher odds of ICU admission (OR 3.09, 95% CI, 1.29-7.38). Conclusion: In this large single -institution study we identify that more than half of patients with ICI-treated NSCLC develop infectious complications. We identify that patients with COPD, recent corticosteroid use, and concomitant irAE and infection have higher odds of hospitalization, and that unusual infections (eg, fungal) can occur. This highlights clinical awareness of infections as important complications during ICI therapy in patients with NSCLC.

Automated summary

Immune checkpoint inhibitors (ICI) have become standard therapy for patients with nonsmall cell lung cancer (NSCLC), however, the burden of infectious complications associated with ICI therapy is poorly described. In a retrospective study of 298 patients with ICI-treated NSCLC, it was found that 54.4% of patients experienced an infection. Patients with chronic obstructive pulmonary disease, recent corticosteroid use, and concomitant immune-related adverse event and infection had worse infectious outcomes.