Prognostic relevance of immune-related adverse events in lung cancer patients undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis
机构：[1]West China School of Medicine, Sichuan University, Chengdu, China.四川大学华西医院[2]Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.四川大学华西医院[3]Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.四川大学华西医院
Immune checkpoint inhibitors (ICIs) work by activating the immune system, a mechanism that may also cause immune-related adverse events (irAEs). This study seeks to investigate on how different irAEs impact prognosis of advanced lung cancer (LC) patients and identify useful approaches to manage irAEs.A thorough literature search of PubMed, Embase, the Cochrane Library and manual searches up to January 2024 were undertaken. Treatment outcomes including progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR) were obtained. Meta-analysis was conducted using R software (version 4.3.1).There were 106 studies with 41,050 advanced or recurrent LC patients included. The occurrence of irAEs was correlated with better PFS [hazard ratio (HR) =0.54; 95% confidence interval (CI): 0.49-0.59], OS (HR =0.57; 0.51-0.63), ORR [risk ratio (RR) =2.03; 95% CI: 1.81-2.28] and DCR (RR =1.55; 95% CI: 1.40-1.72) and remained significant after adjusting programmed death-ligand 1 (PD-L1) level. IrAEs affecting skin (OS: HR =0.45; 95% CI: 0.38-0.53) and endocrine system (OS: HR =0.51; 95% CI: 0.41-0.62), of mild severity (OS: HR =0.52; 95% CI: 0.35-0.79), arising in multiple sites (OS: HR =0.47; 95% CI: 0.38-0.59), induced by monotherapy (OS: HR =0.58; 95% CI: 0.52-0.65), with a delayed onset (cutoff: 3 months; OS: HR =0.37; 95% CI: 0.19-0.71) were identified as positive prognostic markers. In contrast, though pulmonary irAEs were found to be corelated with enhanced treatment response (ORR: RR =1.75; 95% CI: 1.37-2.25), they may harm survival, especially those with grade ≥3 (OS: HR =2.40; 95% CI: 1.39-4.14). Treatment resumption tended to improve PFS but might not reduce the risk of death compared to permanent discontinuation.IrAEs suggest better treatment outcomes generally, yet severe pneumonia could increase mortality risk. Close supervision and appropriate handling protocols are warranted to weigh treatment benefit against risk.2024 Translational Lung Cancer Research. All rights reserved.
基金：
National Natural Science Foundation of China (grant No. 82102968 to principal investigator J.Z.; grant No. 82302624 to principal investigator M.L.), the National Key R&D Program of China (grant No. 2021YFC2500905 to principal investigator C.L.) and the Natural Science Foundation of Sichuan Province (grant No. 2024NSFSC1548 to principal investigator M.L.).
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外文
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出版当年[2023]版：
大类|2 区医学
小类|3 区肿瘤学3 区呼吸系统
最新[2023]版：
大类|2 区医学
小类|3 区肿瘤学3 区呼吸系统
第一作者：
第一作者机构：[1]West China School of Medicine, Sichuan University, Chengdu, China.
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推荐引用方式(GB/T 7714)：
Huang Yuchen,Ma Wananqi,Wu Dongsheng,et al.Prognostic relevance of immune-related adverse events in lung cancer patients undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis[J].Translational Lung Cancer Research.2024,13(7):1559-1584.doi:10.21037/tlcr-24-299.
APA：
Huang Yuchen,Ma Wananqi,Wu Dongsheng,Lyu Mengyuan,Zheng Quan...&Liu Chengwu.(2024).Prognostic relevance of immune-related adverse events in lung cancer patients undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis.Translational Lung Cancer Research,13,(7)
MLA：
Huang Yuchen,et al."Prognostic relevance of immune-related adverse events in lung cancer patients undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis".Translational Lung Cancer Research 13..7(2024):1559-1584
