206P Pragmatic strategies for managing immune-related adverse events in low- and middle-income countries

pneumonitis vary across clinical trials, influenced by the specific ICI agent and treatment line.Clarifying these variations is important for anticipating and managing toxicity, guiding clinical decisions, and optimizing patient safety. Methods:A PRISMA-compliant review (PROSPERO: CRD420251026124) analyzed four databases through April 2025 for trials reporting pneumonitis in NSCLC patients receiving PD-1/PD-L1 inhibitors.Data extraction and risk-of-bias assessment (RoB-2 tool) were performed independently.A random-effects meta-analysis (DerSimonian-Laird method) assessed heterogeneity, sensitivity, and publication bias.Results: Among 13,584 records, 85 studies (20,883 patients) were included.Most evaluated PD-1 inhibitors (nivolumab, pembrolizumab) or PD-L1 inhibitors (atezolizumab, durvalumab).Risk of bias was high in 50% of studies.Pooled all-grade pneumonitis incidence was 6% (PD-1) vs. 8% (PD-L1), with no significant difference by treatment line.Grade 3 pneumonitis occurred in 3% (PD-1) and 2% (PD-L1), with significant variation in PD-L1 subgroups by line (P = 0.0078).Grade 1-2 (1-5%), 3-4 (1-3%), and fatal (grade 5, <1%) pneumonitis incidences were low overall but varied by agent.Heterogeneity was higher in PD-L1 analyses.Conclusions: PD-1/PD-L1 inhibitors pose a low but clinically relevant pneumonitis risk in NSCLC, with PD-L1 agents showing marginally higher all-grade incidence.Severe cases are rare, particularly with second-line PD-L1 use.These findings underscore the need for vigilant monitoring, especially in high-risk patients.Mechanistic studies and improved risk stratification tools are warranted.Further research should explore the mechanisms behind differing pneumonitis risks between PD-1 and PD-L1 inhibitors.Real-world data and head-to-head trials are needed to validate findings and support personalized ICI selection in NSCLC.