Abstract Rationale Pembrolizumab/Nivolumab are both PD-1 immune checkpoint inhibitors that has demonstrated significant improvements in both overall survival and progression-free survival in cancer patients including lung cancers. While their immuno-mediated toxicities are well studied, the comparative effect of these toxicities and their outcomes between these two medications, remains limited. Methods We conducted a retrospective cohort study using TriNetX, a federated global research network aggregating de-identified electronic medical records from large healthcare organizations. Adult patients with Lung cancer were included. Patients were stratified into two groups: those who received combination Chemoimmunotherapy with Pembrolizumab and those who received combination Chemoimmunotherapy with Nivolumab, with both groups receiving standard chemotherapy regimens along with the designated immunotherapy. Propensity score matching (1:1) was performed to balance cohorts by age, sex, HF, COPD, Asthma, ILD, Metastatic disease, Prior thoracic radiation, Oxygen dependence and other comorbidities (CKD, Obesity, DM, Nicotine dependence). The primary outcome was the incidence of pulmonary complications such as ARDS, Pulmonary fibrosis, Pneumonitis, Viral and Bacterial Pneumonia. Secondary outcomes assessed the severity and risk of 30-day all-cause mortality in patients who developed ARDS. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated to compare event rates between groups at each interval. Results A total of 17,640 patients met the inclusion criteria, with 8,820 in each matched cohort. The mean age was 65.8 years in both groups. Chemoimmunotherapy-treated patients using Pembrolizumab had a significantly lower risk of developing ARDS (RR 0.705, 95% CI 0.510, 0.974, P 0.05), all cause 30-day mortality in patients who developed ARDS after the start of treatment with Pembrolizumab vs Nivolumab was not significant (RR 1.150, 95% CI 0.863, 1.532, P = 0.338). Chemoimmunotherapy-treated patients using Pembrolizumab also had a significant increase in the risk of developing Pneumonitis (RR 1.632, 95% CI 1.091, 2.441, P 0.05), Viral Pneumonia (RR 1.764, 95% CI 1.422, 2.188, P 0.001) and Bacterial Pneumonia (RR 1.330, 95% CI 1.183, 1.497, P 0.001) with no significant difference in developing Pulmonary fibrosis (RR 1.068, 95% CI 0.912, 1.250, P = 0.413). Conclusion In general patients who are treated with Pembrolizumab based regimens had significantly increased risk of developing pulmonary toxicities except in ARDS in which patients treated with Pembrolizumab had lower risk. These findings indicate that patients treated with pembrolizumab had worse pulmonary outcomes, prompting need for close monitoring. This abstract is funded by: None
Jabiri et al. (Fri,) studied this question.