Steroid-refractory Interstitial Lung Disease in Patients Receiving Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis

Background: Immune checkpoint inhibitors (ICIs) are a class of anticancer drugs. ICIs have revolutionized cancer therapy by enhancing the immune system’s ability to target tumors. However, they carry a risk of immune-related adverse effects, including interstitial lung disease (ILD). Steroid-refractory ILD in patients undergoing ICI treatment represents a serious condition in which ILD does not respond to standard steroid therapy, requiring alternative management strategies. This systematic review and meta-analysis address the prevalence, characteristics, and outcomes of steroid-refractory ILD in patients undergoing ICI treatment. Methods: A systematic, comprehensive computer search of available literature in various databases was performed; four researchers independently reviewed the articles and excluded ones that did not fit the predetermined eligibility criteria. Results: The analysis covered 2359 patients across 19 studies. We found that the pooled prevalence of steroid-refractory CIP was 12% (95% confidence interval [CI]: 3%–24%). Among patients with lung cancer, the pooled prevalence was 24% (95% CI: 9%–43%), while it was 16% among patients with hematologic malignancies. Higher prevalence was found among males (69%) and smokers (63%) compared to females (38%) and nonsmokers (40%). The pooled mortality rate among patients with steroid-refractory CIP was 32% (95% CI: 12%–55%). Conclusions: Overall, our research emphasizes the need for early detection, careful monitoring, and customized treatment approaches for managing this serious complication, urging further research to refine management strategies and improve patient outcomes.