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Abstract：
BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized nonsmall cell lung cancer (NSCLC) treatment and significantly increased overall survival of patients. However, the incidence of concurrent infections and their management is still debated.
METHODS: From August 2015 to October 2019, all consecutive patients with NSCLC who received nivolumab or pembrolizumab as first- or second-line therapy were retrospectively evaluated. At the time of analysis all patients had died. Clinical characteristics of patients, type of infections, and predictors of mortality were analyzed.
RESULTS: A total of 118 patients were identified: 74 in the nivolumab group and 44 in the pembrolizumab group. At least 1 infection was recorded in 22% of the nivolumab-group versus 27% of the pembrolizumab-group (P = .178). In both groups, the main infection was pneumonia, followed by skin and soft tissue infections, urinary tract infections, and gastroenteritis. Crude mortality for first infection was 10.7%, followed by 25% and 40% for the second and third recurrence, respectively (p for trend = .146). No opportunistic infections were recorded. It is notable that, by Cox-regression model, the independent predictor of mortality was a higher Eastern Cooperative Oncology Group performance status at baseline (P < .001), whereas the multidisciplinary diagnosis and treatment of concurrent infections was associated with a reduced probability of mortality (adjusted hazard ratio = 0.50; 95% confidence interval = 0.30-0.83; P < .001).
CONCLUSIONS: In patients with NSCLC treated with ICIs, multidisciplinary management of concurrent infections may reduce the risk of mortality. Further studies to investigate risk factors for infections, as well as appropriate management strategies and preventive measures in this setting, are warranted.
METHODS: From August 2015 to October 2019, all consecutive patients with NSCLC who received nivolumab or pembrolizumab as first- or second-line therapy were retrospectively evaluated. At the time of analysis all patients had died. Clinical characteristics of patients, type of infections, and predictors of mortality were analyzed.
RESULTS: A total of 118 patients were identified: 74 in the nivolumab group and 44 in the pembrolizumab group. At least 1 infection was recorded in 22% of the nivolumab-group versus 27% of the pembrolizumab-group (P = .178). In both groups, the main infection was pneumonia, followed by skin and soft tissue infections, urinary tract infections, and gastroenteritis. Crude mortality for first infection was 10.7%, followed by 25% and 40% for the second and third recurrence, respectively (p for trend = .146). No opportunistic infections were recorded. It is notable that, by Cox-regression model, the independent predictor of mortality was a higher Eastern Cooperative Oncology Group performance status at baseline (P < .001), whereas the multidisciplinary diagnosis and treatment of concurrent infections was associated with a reduced probability of mortality (adjusted hazard ratio = 0.50; 95% confidence interval = 0.30-0.83; P < .001).
CONCLUSIONS: In patients with NSCLC treated with ICIs, multidisciplinary management of concurrent infections may reduce the risk of mortality. Further studies to investigate risk factors for infections, as well as appropriate management strategies and preventive measures in this setting, are warranted.
摘要：
■免疫检查点抑制剂（ICIs）彻底改变了非小细胞肺癌（NSCLC）的治疗方法，并显着提高了患者的总体生存率。然而,并发感染的发生率及其管理仍存在争议.
从2015年8月至2019年10月，回顾性评估了所有接受纳武单抗或派博利珠单抗作为一线或二线治疗的NSCLC患者。在分析时，所有患者均已死亡。患者的临床特征,感染类型,并分析了死亡率的预测因素。
■共确认118例患者：纳武单抗组74例，派姆单抗组44例。在22％的nivolumab组和27％的pembrolizumab组中记录至少1例感染（P=0.178）。在这两组中,主要感染是肺炎,其次是皮肤和软组织感染，尿路感染,和肠胃炎.首次感染的粗死亡率为10.7%，其次是第二次和第三次复发的25%和40%，分别(趋势p=.146)。没有记录到机会性感染。值得注意的是,通过Cox回归模型，死亡率的独立预测因子是东部肿瘤协作组基线表现状态较高（P<.001），而并发感染的多学科诊断和治疗与死亡率降低相关(校正风险比=0.50;95%置信区间=0.30-0.83;P<.001).
■在接受ICIs治疗的非小细胞肺癌患者中，并发感染的多学科管理可降低死亡风险.进一步研究以调查感染的危险因素，以及在这种情况下的适当管理策略和预防措施，是有保证的。
从2015年8月至2019年10月，回顾性评估了所有接受纳武单抗或派博利珠单抗作为一线或二线治疗的NSCLC患者。在分析时，所有患者均已死亡。患者的临床特征,感染类型,并分析了死亡率的预测因素。
■共确认118例患者：纳武单抗组74例，派姆单抗组44例。在22％的nivolumab组和27％的pembrolizumab组中记录至少1例感染（P=0.178）。在这两组中,主要感染是肺炎,其次是皮肤和软组织感染，尿路感染,和肠胃炎.首次感染的粗死亡率为10.7%，其次是第二次和第三次复发的25%和40%，分别(趋势p=.146)。没有记录到机会性感染。值得注意的是,通过Cox回归模型，死亡率的独立预测因子是东部肿瘤协作组基线表现状态较高（P<.001），而并发感染的多学科诊断和治疗与死亡率降低相关(校正风险比=0.50;95%置信区间=0.30-0.83;P<.001).
■在接受ICIs治疗的非小细胞肺癌患者中，并发感染的多学科管理可降低死亡风险.进一步研究以调查感染的危险因素，以及在这种情况下的适当管理策略和预防措施，是有保证的。
