Impact des images radiologiques alvéolo-interstitielles pré-thérapeutiques sur le développement des pneumopathies induites par l'immunothérapie chez les patients atteints de cancer bronchique non à petites cellules

Abstract : Introduction. Immunotherapy (IT) in the treatment of non-small cell lung cancer (NSCLC) has revealed a new toxicity profile including pneumonitis. There are often some restrictions about IT treatment of patients with prior alveolar-interstitial radiological images (AIRI). However, their presence is not always described and their role in the development of pneumonitis remains unknown. The main objective of our study was to evaluate the incidence of pneumonitis in the presence of AIRI on the CT scan before IT. The secondary objectives focused on the incidence of pneumonitis based on clinical characteristics, the comparison between initial report and rereading of scanners by associated radiologists, overall survival (OS) and progression free survival (PFS) data. Methods. A retrospective study was conducted on patients with NSCLC treated with IT. Clinical, radiological (initial CR and rereading) and treatment data were collected from computerized medical records. Results. A total of 156 patients were included, mostly men (n = 108, 69.2%). 120 patients had an initial ARAI and 23 developed a pneumonitis. The presence of ARAI on the initial CT scan was not associated with the development of a pneumonitis, however the traction bronchiectasis (TB) present before IT was a risk factor for pneumonitis (OR 0.25, 95%CI[0.71-0.86], p = 0.035). No clinical factors studied were significantly associated with the incidence of pneumonitis. The comparison between CT report and rereading by radiologists found significant differences in the presence of AIRI with coefficient of variation of 41.1% to 52.5%. The presence of interlobular septa (ILS) on the initial CT scan and the presence of symptoms in the ARAI group was associated with shorter OS (p = 0.038 and p = 0.051). PFS was shorter in the presence of ILS (HR 1.52, 95%C[1.07-2.16], p = 0.020) or micronodules (HR 1.54, 95%CI [1.07-2.22], p = 0.021). Conclusion. The association between pneumonitis and TB (associated with fibrosis), may limit the prescription of IT in this context and raises the question of the influence of microbiota and antibiotherapies on pneumonitis occurrence The great difference found in the description of pre-therapeutic AIRI between initial reports and rereading of CT scans suggests the need for a better communication with the radiologists, for example with the development of a radiologic check-list before IT.
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Master thesis
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Fanny Jean. Impact des images radiologiques alvéolo-interstitielles pré-thérapeutiques sur le développement des pneumopathies induites par l'immunothérapie chez les patients atteints de cancer bronchique non à petites cellules. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01924580⟩

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