Abstract
To investigate the clinical and radiologic characteristics and risk factors of anaplastic lymphoma kinase (ALK) inhibitor induced pneumonitis (ALK-IIP) in patients with non-small cell lung cancer (NSCLC). A total of 250 NSCLC patients who had been treated with ALK inhibitors from January 2015 to January 2018 were retrospectively enrolled. Clinical characteristics and clinical course were reviewed from the medical records. Chest CT of ALK-IIP was analyzed and classified into four CT patterns, i.e. organizing pneumonia (OP), hypersensitivity pneumonitis (HP), diffuse alveolar damage (DAD), and nonspecific interstitial pneumonia (NSIP), using the American Thoracic Society/European Respiratory Society classification of interstitial pneumonia. Clinical characteristics including toxicity grading according to the National Cancer Institute Common Terminology Criteria for Adverse Events and treatment course was analyzed in regarding to the classified CT patterns. Clinical characteristics were compared between patients with ALK-IIP and without ALK-IIP. ALK-IIP was identified in 11 patients (4.4%). The most common CT pattern was the OP pattern (n = 7, 63.6%) and followed by the HP pattern (n = 2, 18.2%) and the DAD pattern (n = 2, 18.2%). ALK-IIP showed pneumonitis toxicity grade ranged from 1 to 3, and DAD pattern had the highest toxicity grade, followed by HP and OP patterns (median grade: 3.5, 2.5, 1). All of the patients with the OP pattern were successfully treated, while half of patients with the DAD pattern died during treatment. The smoking history and extrathoracic metastasis were more frequent in patients with ALK-IIP (P <0.005). The smoking history was associated with a higher incidence of ALK-IIP [odds ratio: 3.586, 95% confidence interval: 1.058-13.432, P = 0.049]. ALK-IIP showed a spectrum of chest CT patterns and various toxicity grades, and CT patterns reflected the toxicity grades of ALK-IIP. The OP pattern was the most common CT pattern of ALK-IIP, and patients with ALK-IIP of the OP pattern were successfully treated. ALK inhibitors should be used with caution in NSCLC patients with smoking history.
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