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

Hindocha, S., Campbell, D., Ahmed, M. , Giorgakoudi, K. ORCID: 0000-0002-5925-1846, Sharma, B., Yousaf, N., Molyneaux, P., Hunter, B., Kalsi, H., Cui, W., Davidson, M., Bhosle, J., Minchom, A., Locke, I., Mcdonald, F., O'brien, M., Popat, S. & Lee, R. W. (2021). Immune Checkpoint Inhibitor and Radiotherapy-Related Pneumonitis: An Informatics Approach to Determine Real-World Incidence, Severity, Management & Resource Implications. Frontiers in Medicine, 8, article number 764563. doi: 10.3389/fmed.2021.764563


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 1/1/2015-31/12/2020. 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.

Publication Type: Article
Additional Information: © 2021 Hindocha, Campbell, Ahmed, Giorgakoudi, Sharma, Yousaf, Molyneaux, Hunter, Kalsi, Cui, Davidson, Bhosle, Minchom, Locke, Mcdonald, O'brien, Popat and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Publisher Keywords: Pneumonitis, Immunotherapy, Checkpoint inhibitor, Radiotherapy, Informatics, Health Economics
Subjects: R Medicine > RC Internal medicine
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
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