Gemcitabine Following Lung Cancer Treatment with Immune Checkpoint Inhibitors: A Potential Risk of Pneumocystis jirovecii Pneumonia

Astrid Mercier, Clément Foignot, Ayoub Zouak, Fleur-Marie Quilot, Courèche Kaderbhai, Ludwig Serge Aho Glélé, Philippe Bonniaud, Marjolaine Georges and Pascal Foucher

Department of Thoracic Oncology, CHU, Dijon, France
Department of Pulmonary Medicine, Hospital Center Les Chanaux, France
Department of Pulmonary Medicine, Intensive Care Unit, University Hospital, France
Department of Medical Oncology, Center GF Leclerc, France
Department of Hospital Epidemiology and Infection Control, Dijon University Hospital, France

^*Correspondance to: Philippe Bonniaud 

 PDF  Full Text Research Article | Open Access

Abstract:

Background: Immunocompromised patients are susceptible to severe Pneumocystis jirovecii Pneumonia (PJP). The aim of this study is to compare the incidence rate of PJP among patients with solid cancer treated either with gemcitabine after a first-line Immune Checkpoint Inhibitor (ICI) or after a different regimen of anti-cancer treatments.
Methods: Retrospective study of data from patients treated for a solid cancer (mostly lung cancers) and with a diagnosis of PJP, between January 01st, 2017 and June 30th, 2020. We formed four groups of patients: Gemcitabine after ICI (IG group), chemotherapy without prior ICI (C group), chemotherapy other than gemcitabine after ICI (IC group), and ICI just before the diagnosis of PJP (I group).
Results: Among the 210 patients with a microbiologically confirmed diagnosis of PJP, we included 23 patients for whom the diagnosis of PJP was retained: 7 patients in the IG group, 13 patients in the C group, 1 patient in the IC group, 2 patients in the I group. The incidence rate of PCP was significantly higher (p<0.001) in the IG group (0.074) compared to the 3 other groups (0.002 in the C group, 0.001 in the IC group and 0.003 in the I group).
Conclusion: The incidence rate of PJP in patients treated for a solid cancer and who received gemcitabine chemotherapy following prior ICI seems significantly higher than among patients who received other treatment regimens. In practice, our work raises the question of the introduction of preventive treatment for PJP in these patients.

Keywords:

Pneumocystis jirovecii pneumonia; Immune checkpoint inhibitor; Gemcitabine; Bronchoalveolar lavage; Lung cancer

Cite the Article:

Mercier A, Foignot C, Zouak A, Quilot F-M, Kaderbhai C, Glélé LSA, et al. Gemcitabine Following Lung Cancer Treatment with Immune Checkpoint Inhibitors: A Potential Risk of Pneumocystis jirovecii Pneumonia. Clin Oncol. 2022;7:1944..