Immune checkpoint inhibitors and respiratory outcomes in cancer patients with pre-existing asthma: A TriNetX propensity-matched cohort study.

11150 Background: Immune checkpoint inhibitors (ICIs) are associated with immune-related pulmonary toxicity. Real-world data on outcomes in patients with pre-existing asthma across malignancies remain limited. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network (170 HCOs). Adults (≥18 years) with asthma (ICD-10 J45) and malignancy (ICD-10 C00–C96) were identified. The ICI cohort included patients receiving ICIs (HCPCS J9271, J9299, J9119, J9272, J9345, J9022, J9173, J9023, J9228, J9347) after cancer diagnosis (first ICI within 3 years of first malignancy). The comparator cohort included patients receiving non-ICI systemic therapy (TNX:1002 chemotherapy, TNX:1003 targeted therapy, TNX:1004 hormone therapy, and/or Z51.11) and excluded ICI exposure. Outcomes were assessed from day 1 through day 1095 after index. Propensity score matching (1:1) was performed (final N = 4,074 per cohort). Results: In the matched cohorts (N = 4,074 each), ICI exposure was associated with higher risks of inpatient admissions (41.65% vs 32.78%; RR 1.27; HR 1.22), all-cause mortality (47.62% vs 38.76%; RR 1.23; HR 1.44), respiratory failure (J96) (25.01% vs 15.13%; RR 1.65; HR 1.66), and drug-induced interstitial lung disorders (1.91% vs 0.87%; RR 2.20; HR 4.26). ICI exposure was also associated with increased risk of mechanical ventilation (4.00% vs 2.93%; RR 1.36; HR 1.45), emergency intubation (2.55% vs 2.00%; RR 1.27; HR 1.32), and ED visits (38.98% vs 31.56%; RR 1.24; HR 1.74). Asthma exacerbation (J45.901) showed a modest increase in risk (RR 1.23), with survival analysis not reaching statistical significance (HR 1.15; p = 0.078). Conclusions: Among adults with asthma and cancer, ICI exposure was associated with increased risks of hospitalization, respiratory failure, drug-induced interstitial lung disorders, and mortality compared with non-ICI systemic therapy. These findings support close pulmonary monitoring and risk mitigation when initiating ICIs in patients with asthma.