Open AccessRisk of immune‐related pneumonitis for PD 1/ PD ‐L1 inhibitors: Systematic review and network meta‐analysis
Author(s) -
Huang Yafang,
Fan Haiyu,
Li Ning,
Du Juan
Publication year - 2019
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.2104
Subject(s) - nivolumab , medicine , pneumonitis , ipilimumab , adverse effect , pembrolizumab , randomized controlled trial , odds ratio , oncology , gastroenterology , cancer , immunotherapy , lung
Background Immune‐related pneumonitis is a clinically relevant and potentially life‐threatening adverse event. We performed a systematic review and network meta‐analysis to compare the risk of immune‐related pneumonitis among different PD 1/ PD ‐L1 inhibitor‐related therapeutic regimens. Methods Randomized controlled trials with PD 1/ PD ‐L1 inhibitors were identified through comprehensive searches of multiple databases. Both published and unpublished data were extracted. Bayesian NMA was performed using random‐effects models. All‐grade (Grade 1‐5) and high‐grade (Grade 3‐5) immune‐related pneumonitis were estimated using odds ratios ( OR s). Results A total of 25 studies involving 16 005 patients were included. Compared with chemotherapy, the OR s of immune‐related all‐grade and high‐grade pneumonitis were significant for nivolumab (all‐grade: OR = 6.29, 95% CrI: 2.67‐16.75; high‐grade: OR = 5.95, 95% CrI: 2.35‐17.29), pembrolizumab (all‐grade: OR = 5.78, 95% CrI: 2.79‐13.24; high‐grade: OR = 5.33, 95% CrI: 2.49‐12.97), and nivolumab plus ipilimumab therapy (all‐grade: OR = 14.82, 95% CrI: 5.48‐47.97; high‐grade: OR = 15.26, 95% CrI: 5.05‐55.52). Compared with nivolumab, nivolumab plus ipilimumab therapy was associated with an increased risk of all‐grade pneumonitis ( OR = 2.34, 95% CrI: 1.07‐5.77). Nivolumab plus ipilimumab therapy had the highest risk of both all‐grade and high‐grade pneumonitis among PD 1/ PD ‐L1 inhibitor‐related therapeutic regimens. Conclusions This study demonstrates that compared with chemotherapy, PD ‐1 inhibitor may result in a higher risk of immune‐related pneumonitis. Nivolumab plus ipilimumab therapy had the highest pneumonitis risk. These findings could be taken into account by the physicians in decision making.