Emerging concern of infectious diseases in lung cancer patients receiving immune checkpoint inhibitor therapy

Abstract

<b>Background:</b> Non-small cell lung cancer (NSCLC) is one of the most studied cancers in cancer immunotherapy. Immune checkpoint inhibitors (ICIs) have unique immune related adverse effects. However, little is known about infectious diseases occurring during ICI treatment. <b>Aims and Objectives:</b> To examine the incidence and risk factors of infectious diseases in NSCLC patients receiving ICIs. <b>Methods:</b> We retrospectively reviewed NSCLC patients who received nivolumab, one of the ICIs, at National Hospital Organization Kyoto Medical Center and Kyoto University Hospital between December 2015 and November 2016. We counted all infectious diseases, occurring after initiation of nivolumab until 6 months after discontinuation. <b>Results:</b> Eighty-four NSCLC patients received nivolumab during the observational period. Of 84 patients, 20 (23.8%) patients developed an infectious disease. Fifteen patients (pneumonia, 9; lung abscess, 1; bloodstream infection, 2; skin infection, 2; tuberculosis, 1), two patients (Aspergillus, 1; Trichophyton, 1) and three patients (Zoster, 1; influenza, 2) developed bacterial, fungal and viral infection, respectively. There were no significant differences in characteristics, number of prior chemotherapies and nivolumab between patients with and without infection. Of 20 patients with infection, 10 (50%) had a history of steroid use during nivolumab treatment. However, there was no significant difference in corticosteroid use between patients with and without infection (50% vs. 56%, P=0.62). <b>Conclusion:</b> Incidence of infectious diseases was relatively high in patients with nivolumab treatment. ICI has a potential risk for infectious disease regardless of steroid use.