Atezolizumab for pretreated NSCLC with idiopathic interstitial pneumonias

What is it about?

A multicenter, single arm phase II trial to assess the safety and efficacy of atezolizumab for patients with pretreated advanced or recurrent NSCLC complicated with idiopathic interstitial pneumonias

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Photo by Robina Weermeijer on Unsplash

Photo by Robina Weermeijer on Unsplash

Why is it important?

Interstitial pneumonia (IP) is one of common and poor prognostic comorbidities in patients with non-small cell lung cancer (NSCLC) and is also a known risk factor for pneumonitis. Thus far, there has been currently no standard second-line or later therapies for advanced NSCLC with IP. However, two small single-arm trials of nivolumab showed safety in pretreated NSCLC patients with “mild” idiopathic IP. Atezolizumab, an anti-programmed cell death-ligand 1 antibody, is an established treatment for previously treated NSCLC patients, and were reported to have a lower risk of pneumonitis than anti-PD-1 antibodies. In this regard, we launched a multicenter, single arm phase II trial to assess the safety and efficacy of atezolizumab for patients with pretreated advanced or recurrent NSCLC complicated with idiopathic IP. However, this study was terminated early due to the high incidence of pneumonitis, including 4 patients (23.5%) who had grade 3-5 pneumonitis. We would like to inform the risks of immune checkpoint inhibitors for patients with this population, especially to physicians using similar treatments in practice and those planning similar studies. In the present situation where coronavirus disease 2019 (COVID-19) is rapidly spreading around the world, the additional difficulty of differentiating between ICI-induced pneumonitis and COVID-19-associated pneumonia can arise. Therefore, more prudence should be exercised when considering the administration of ICIs for NSCLC patients with IP.

Perspectives