Safety of thoracic radiotherapy in patients with prior immune-related adverse events from immune checkpoint inhibitors

摘要: Background Immune checkpoint inhibitors (ICIs) and thoracic radiotherapy are increasingly used to treat advanced cancers. Despite data indicating exaggerated radiation toxicities in patients with autoimmune disease, the safety of prior ICI-associated immune-related adverse events (irAEs) is undefined. Patients methods treated from 2014 2020 ICIs were queried for receipt corticosteroids radiotherapy. who received after symptomatic irAEs assessed ≥grade 2 pneumonitis (RP). Characteristics predictive RP using logistic regression response relationships modeled. Results Among 496 patients, 41 irAE history subsequently analyzed. Most grade (n = 21) 3 19). Median time onset was 8.1 months. stereotactic body therapy 20) or hypofractionated 18). In total, 25 (61%) developed at a median 4 months 11 irAEs. Three onset, 16 24 (67%) assessable had persistent symptoms. ICI 6), five (83%) (grade 2, n = 3; ≥3, 2). The mean lung dose (MLD) predicted (odds ratio: 1.60, P = 0.00002). relationship between MLD strong (area under receiver-operating characteristic curve: 0.85) showed an dose-response. >5 Gy 26), 21 (81%) RP. Conclusion This first study assessing toxicity among ICIs. found be very high risk clinically significant Careful consideration should given possibility increased RP, close monitoring recommended these patients.