Supplementary Figure Legends from Radiological Patterns of Drug-induced Interstitial Lung Disease (DILD) in Early-phase Oncology Clinical Trials

Abstract

<p>Figure S1A. Correlation of patterns of DILD as per ATS/ERS classification and clinical severity. AIP correlated significantly with worse severity (P=0.002). NSIP, non-specific interstitial pneumonia; COP, cryptogenic organizing pneumonia; AIP, acute interstitial pneumonia; HP, hypersensitivity pneumonitis. Figure S1B. A higher RMH DILD score predicts for increasing clinical severity of DILD as per CTCAE grading. Shown are CTCAE grading and RMH DILD Score at the time of DILD detection. Box plot mapping RMH DILD Scores against CTCAE grading showing statistically significant worsening of CTCAE grading and symptoms with higher RMH DILD score (P=0.004); DILD was confirmed to be the cause of death in one patient who had an initial RMH DILD score of 5 and was asymptomatic with an excellent partial response to therapy and so was continued on therapy. This patient then developed symptomatic DILD with a worsening RMH DILD score of 8, deteriorated and died. RMH DILD score, Royal Marsden Hospital Score for drug induced interstitial lung disease; CTCAE, Common Terminology Criteria for Adverse Events Version 5.0. Figure S2. Continuation of IMP following radiological detection of asymptomatic DILD resulting in clinical deterioration. Images from a patient with breast cancer treated with an investigational drug-conjugate. Patient had no prior lung disease and no lung metastases at baseline. Cartoons (left) show RMH DILD scoring of matched sagittal radiographic images (right). The first row shows initial development of radiographic changes after 2 cycles of treatment when patient was asymptomatic (RMH DILD score of 5) and otherwise had a remarkable RECIST PR. With a further cycle of treatment, the changes had significantly worsened (RMH DILD score of 8), with development of rapidly progressive clinical symptoms which was ultimately fatal despite treatment with antibiotics, steroids, and respiratory support.</p>