246P Detection of drug-induced interstitial lung disease caused by cancer treatment using electronic nose exhaled breath analysis

Many cancer treatments are associated with potentially life-threatening drug-induced interstitial lung disease (DIILD), also known as drug-related pneumonitis. Chest CT scan is used for screening and monitoring DIILD in patients on high-risk treatment, but is often inconclusive in suspected cases. Therefore, a non-invasive, rapid, and accessible test to facilitate frequent monitoring, timely diagnosis and adequate treatment of DIILD is needed. Electronic nose (eNose) analyzes exhaled breath in real-time. We showed previously that eNose has potential as point-of-care test to detect ILD. We investigated whether eNose technology can differentiate between patients with cancer who have DIILD and those without DIILD. In a cross-sectional study, patients with a pathology-proven solid cancer diagnosis and suspected DIILD were included as cases. After inclusion, cases were discussed within a multidisciplinary team and excluded if DIILD was rejected. Patients without DIILD served as controls, matched for cancer diagnosis and treatment. Exhaled breath analysis using eNose (SpiroNose®) was performed. Data were analyzed using sparse partial least squares discriminant and receiver operating characteristic analyses. Twenty patients in both case and control group were included, of whom 40% had lung cancer. DIILD occurred at median 2.8 [1.5, 6.1] months after start of cause-related treatment and 11 (55%) cases received steroids for DIILD. All baseline characteristics are displayed in the table. Comparing eNose data of both groups resulted in an area under the curve of 0.81 (95%CI 0.67-0.95) with corresponding sensitivity and specificity of 0.75. Table: 246PBaselineCase n=20Control n=20Female9 (45)9 (45)Age65.25 ±11.6767.6 ±9.4Smoking:Never3 (15)7 (35)Former17 (85)13 (65)Cancer diagnosis:Lung8 (40)8 (40)Urogenital5 (25)5 (25)Melanoma4 (20)4 (20)Mesothelioma3 (15)3 (15)Treatment:Nivolumab (ipilimumab)8 (40)8 (40)Pembrolizumab, pemetrexed, carboplatin4 (20)4 (20)Sotorasib2 (10)2 (10)Capmatinib1 (5)1 (5)Dabrafenib, trametinib1 (5)1 (5)Gemcitabine (carboplatin)1 (5)1 (5)GEN1046-04 (pembrolizumab)1 (5)1 (5)Osimertinib1 (5)1 (5)Taxane1 (5)1 (5)Start treatment to DIILD (mo)2.8 [1.5,6.1]Steroid use11 (55)MDT likelihood DIILD:51-69%2 (10)71-89%8 (40)≥90%10 (50)CTCAE DIILD:I-II8 (40)III-IV9 (45)V3 (15) Open table in a new tab In a cohort of patients with various types of cancer and treatment, eNose technology seems to distinguish patients with and without DIILD. These findings encourage validation of eNose for identification of DIILD, in the current era of expanding access to pulmonary toxic cancer treatments.