Adverse events of different PD-1 inhibitors in lung cancer patients: a real-world study

Background: Programmed death-1 (PD-1) inhibitors have been approved and are currently widely used to treat lung cancer patients. However, comparative data on the adverse events (AEs) associated with different PD-1 inhibitors are very limited. Methods: Patients with histologically confirmed lung cancer who had been treated with at least 1 dose of PD-1 inhibitors between January 2017 and December 2019 at a tertiary cancer hospital were included in the study. Data on treatment-related AEs (tr-AEs) were collected from their electronic medical records. Results: A total of 227 lung cancer patients treated with nivolumab (n=83), pembrolizumab (n=65), camrelizumab (n=27), sintilimab (n=31), and toripalimab (n=21) were included. In relation to nivolumab, pembrolizumab, camrelizumab, sintilimab, and toripalimab, the incidence rates of all-grade tr-AEs were 37.34%, 24.62%, 62.96%, 29.03% and 9.52%, respectively (P=0. 01), and the incidence rates of grade 3-4 tr-AEs were 2.41%, 3.08%, 22.22%, 3.23% and 0%, respectively (P=0.05). The most common allgrade tr-AEs were capillary hemangioma (22.22%) and abnormal liver function (22.22%) for camrelizumab, pneumonitis for nivolumab (12.05%), pembrolizumab (6.15%) and nausea/vomiting (12.9%) for sintilimab, and pneumonitis (4.76%), rash/pruritus (4.76%) and shingles (4.76%) for toripalimab. Sex, age, PD-1 inhibitors, histology type and PD-1 cycles were significantly associated with tr-AEs. Conclusions: There were significant differences in the incidence and most common tr-AEs among the different PD-1 inhibitors. Different monitoring priorities should be given to different PD-1 inhibitors during treatment cycles.