Immune Checkpoint Inhibitor and Radiotherapy-Related Pneumonitis: An Informatics Approach to Determine Real-World Incidence, Severity, Management, and Resource Implications.

Autor:	Hindocha S; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom.; Artificial Intelligence (AI) for Healthcare Centre for Doctoral Training, Imperial CollegeLondon, London, United Kingdom.; Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom., Campbell D; Performance & Information Department, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., Ahmed M; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., Giorgakoudi K; Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom.; School of Health Sciences, City University of London, London, United Kingdom., Sharma B; Radiology Department, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., Yousaf N; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., Molyneaux P; Fibrosis Research Group, Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom., Hunter B; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom.; Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom., Kalsi H; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., Cui W; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., Davidson M; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom., Bhosle J; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom., Minchom A; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom., Locke I; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., McDonald F; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., O'Brien M; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom., Popat S; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom., Lee RW; Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom.; Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom.; Fibrosis Research Group, Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Frontiers in medicine [Front Med (Lausanne)] 2021 Nov 01; Vol. 8, pp. 764563. Date of Electronic Publication: 2021 Nov 01 (Print Publication: 2021).
DOI:	10.3389/fmed.2021.764563
Abstrakt:	Pneumonitis is a well-described, potentially life-threatening adverse effect of immune checkpoint inhibitors (ICI) and thoracic radiotherapy. It can require additional investigations, treatment, and interruption of cancer therapy. It is important for clinicians to have an awareness of its incidence and severity, however real-world data are lacking and do not always correlate with findings from clinical trials. Similarly, there is a dearth of information on cost impact of symptomatic pneumonitis. Informatics approaches are increasingly being applied to healthcare data for their ability to identify specific patient cohorts efficiently, at scale. We developed a Structured Query Language (SQL)-based informatics algorithm which we applied to CT report text to identify cases of ICI and radiotherapy pneumonitis between 1/1/2015 and 31/12/2020. Further data on severity, investigations, medical management were also acquired from the electronic health record. We identified 248 cases of pneumonitis attributable to ICI and/or radiotherapy, of which 139 were symptomatic with CTCAE severity grade 2 or more. The grade ≥2 ICI pneumonitis incidence in our cohort is 5.43%, greater than the all-grade 1.3-2.7% incidence reported in the literature. Time to onset of ICI pneumonitis was also longer in our cohort (mean 4.5 months, range 4 days-21 months), compared to the median 2.7 months (range 9 days-19.2 months) described in the literature. The estimated average healthcare cost of symptomatic pneumonitis is £3932.33 per patient. In this study we use an informatics approach to present new real-world data on the incidence, severity, management, and resource burden of ICI and radiotherapy pneumonitis. To our knowledge, this is the first study to look at real-world incidence and healthcare resource utilisation at the per-patient level in a UK cancer hospital. Improved management of pneumonitis may facilitate prompt continuation of cancer therapy, and improved outcomes for this not insubstantial cohort of patients. Competing Interests: SH is funded by the UKRI CDT in AI for Healthcare http://ai4health.io (Grant No. P/S023283/1), by Imperial College London and by the Royal Marsden & Institute of Cancer Research NIHR Biomedical Research Centre. KG is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. WC receives grant funding from Breast Cancer Trials, funding from Australian Government Research Training scholarship and honoraria from Janssen and AstraZeneca, outside the submitted work. BH is funded by Cancer Research UK and Royal Marsden Partners. HK is funded by the Royal Marsden Cancer Charity. PM is supported by the Action for Pulmonary Fibrosis Mike Bray Fellowship. FM reports speaker fees from Astra Zeneca, Elekta, and Takeda; research grant funding from MSD and consulting fees from Astra Zeneca and Accuray, outside of the submitted work. MO'B reports advisory work for MSD, BI, Abbot, Pierre Fabre, and Roche outside the submitted work. SP reports personal fees from BMS, Roche, Takeda, AstraZeneca, Pfizer, MSD, EMD Serono, Guardant Health, Abbvie, Boehringer Ingelheim, OncLive, Medscape, Incyte, Paradox Pharmaceuticals, Eli Lilly, outside the submitted work. RL is funded by the Royal Marsden Cancer Charity with grant funding from Cancer Research UK, Innovate UK (co-funded with Roche and Optellum), and RM Partners outside of the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Hindocha, Campbell, Ahmed, Giorgakoudi, Sharma, Yousaf, Molyneaux, Hunter, Kalsi, Cui, Davidson, Bhosle, Minchom, Locke, McDonald, O'Brien, Popat and Lee.)
Databáze:	MEDLINE
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