Grade 3 and above opportunistic pneumonia or drug-induced interstitial lung disease during tyrosine-kinase inhibitor treatment for advanced non-small-cell lung cancer with RET fusion mutations: coexistence of risks and opportunities

OBJECTIVE: To assess the incidence of grade 3 or higher opportunistic pneumonia or drug-induced interstitial lung disease (DILD) during the treatment of patients with advanced RET fusion-positive (RET +) non-small-cell lung cancer (NSCLC) using pralsetinib. METHODS: A retrospective analysis was conducted on the clinical data of 44 patients with advanced RET + NSCLC treated at Chinese PLA General Hospital from March 2017 to October 2023. Patients were divided into a severe pneumonia group and a control group using propensity score matching, and differences in efficacy, survival, and prognostic factors were compared between the two groups. RESULTS: Nine patients were in the severe pneumonia group and 35 in the control group. The objective response rate (ORR) for RET + NSCLC patients was 50%, and for the severe pneumonia group, 62.5%. There was no significant difference in the median progression-free survival (PFS) and overall survival (OS) between the two groups. An ECOG score of ≥ 2 was an important prognostic factor affecting OS (HR = 4.55, P = 0.016), while the impact of severe infectious pneumonia did not reach statistical significance. CONCLUSIONS: These findings provide new insights into the individualized treatment of RET + NSCLC patients and emphasize the importance of considering the overall health status of patients in treatment decisions.