Immune Checkpoint Inhibitor and Radiotherapy-Related Pneumonitis: An Informatics Approach to Determine Real-World Incidence, Severity, Management, and Resource Implications

Frontiers in Medicine

Merina Ahmed¹  Sumeet Hindocha³  Kyriaki Giorgakoudi³  Richard W. Lee³  Hardeep Kalsi³  Fiona McDonald⁵  Michael Davidson⁵  Benjamin Hunter⁵  Wanyuan Cui⁵  Mary O'Brien⁵  Philip Molyneaux⁵  Imogen Locke⁶  Sanjay Popat⁶  Jaishree Bhosle⁶  Anna Minchom⁶  Des Campbell⁷  Nadia Yousaf⁸  Bhupinder Sharma⁹ 

[1] Information Department, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom;Artificial Intelligence (AI) for Healthcare Centre for Doctoral Training, Imperial CollegeLondon, London, United Kingdom;Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom;Fibrosis Research Group, Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom;Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom;Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom;;Performance &Radiology Department, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom;School of Health Sciences, City University of London, London, United Kingdom;

关键词: pneumonitis;    immunotherapy;    checkpoint inhibitor;    radiotherapy;    informatics;    health economics;   

DOI  :  10.3389/fmed.2021.764563

来源: DOAJ

【 摘 要 】

Pneumonitis is a well-described, potentially life-threatening adverse effect of immune checkpoint inhibitors (ICI) and thoracic radiotherapy. It can require additional investigations, treatment, and interruption of cancer therapy. It is important for clinicians to have an awareness of its incidence and severity, however real-world data are lacking and do not always correlate with findings from clinical trials. Similarly, there is a dearth of information on cost impact of symptomatic pneumonitis. Informatics approaches are increasingly being applied to healthcare data for their ability to identify specific patient cohorts efficiently, at scale. We developed a Structured Query Language (SQL)-based informatics algorithm which we applied to CT report text to identify cases of ICI and radiotherapy pneumonitis between 1/1/2015 and 31/12/2020. Further data on severity, investigations, medical management were also acquired from the electronic health record. We identified 248 cases of pneumonitis attributable to ICI and/or radiotherapy, of which 139 were symptomatic with CTCAE severity grade 2 or more. The grade ≥2 ICI pneumonitis incidence in our cohort is 5.43%, greater than the all-grade 1.3–2.7% incidence reported in the literature. Time to onset of ICI pneumonitis was also longer in our cohort (mean 4.5 months, range 4 days-21 months), compared to the median 2.7 months (range 9 days−19.2 months) described in the literature. The estimated average healthcare cost of symptomatic pneumonitis is £3932.33 per patient. In this study we use an informatics approach to present new real-world data on the incidence, severity, management, and resource burden of ICI and radiotherapy pneumonitis. To our knowledge, this is the first study to look at real-world incidence and healthcare resource utilisation at the per-patient level in a UK cancer hospital. Improved management of pneumonitis may facilitate prompt continuation of cancer therapy, and improved outcomes for this not insubstantial cohort of patients.

【 授权许可】

Unknown