What question did this study set out to answer?

The study aims to determine if pre-treatment interstitial lung abnormalities increase the risk for immune checkpoint inhibitor pneumonitis in locally advanced NSCLC patients treated with chemoradiation.

May 20, 2026

C110-19 Association of Pre-treatment Interstitial Lung Abnormalities in Patients With Locally Advanced Non-smell Lung Cancer With Risk for Immune Checkpoint Inhibitor Pneumonitis

Key Points

The study aims to determine if pre-treatment interstitial lung abnormalities increase the risk for immune checkpoint inhibitor pneumonitis in locally advanced NSCLC patients treated with chemoradiation.
Retrospective review of baseline chest CT scans from 97 patients enrolled in the Gateway project.
Patients underwent concurrent chemoradiation followed by a minimum of three months of immune checkpoint inhibitor therapy.
Interstitial lung abnormalities were classified based on Fleischner Society criteria.
The incidence of ICI pneumonitis in the cohort was 28%.
Traction bronchiectasis was strongly associated with ICI pneumonitis (OR 9.4; 95% CI: 1.9-47).
Ground-glass opacities also showed a significant association with ICI pneumonitis (OR 3.3; 95% CI: 1.22-8.9).

Abstract

Abstract Rationale Patients with locally advanced non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation (CRT) and immune checkpoint inhibitors (ICI) are at high risk for developing ICI pneumonitis (ICI-P). Prior studies suggest that pre-treatment interstitial lung abnormalities (ILAs) increase the risk for ICI-P, but these studies have not focused on locally advanced NSCLC treated with CRT-ICI. We sought to determine whether pre-treatment ILA patterns increase the risk for ICI-P in locally advanced NSCLC treated with CRT-ICI. Methods Baseline chest CT scans from 97 patients enrolled in the Gateway project were retrospectively reviewed. Inclusion criteria required standard of care CRT followed by three months minimum of ICI therapy. ILAs were classified based on Fleischner Society criteria into: no ILA, any ILA, subpleural ILA, and subpleural fibrotic (SF) ILA. Measured ILAs included ground-glass opacities (GGO), reticular opacities, honeycombing, traction bronchiectasis, and architectural distortion. ILAs were coded as present or absent and ICI-P development was defined as a binary outcome. Univariable logistic regression models were used to evaluate associations between ILAs and pneumonitis. Results The incidence of ICI pneumonitis in our cohort was 28%. There was no significant association between age or sex and ICI-P. SF ILAs showed a borderline association with ICI-P (OR 3.0; 95% CI: 0.88-10.0). ILAs most associated with ICI-P were GGOs (OR 3.3; 95% CI: 1.22-8.9) and traction bronchiectasis (OR 9.4; 95% CI: 1.9-47). Subpleural GGOs showed a similar association to ICI-P as any GGOs (OR 3.4; 95% CI: 1.1-10.6). Conclusions Pre-treatment traction bronchiectasis appears to be the strongest predictor of ICI-related pneumonitis, supporting previous studies showing the association of traction bronchiectasis with progression from ILA to interstitial lung disease. Study limitations include small sample size, lack of multiple testing correction, and possible underestimation of ICI-P due to censoring from disease progression. Future analyses incorporating competing risk models and quantitative ILA scores are underway. This abstract is funded by: None

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