免疫检查点抑制剂（ICIs）已显示出在肿瘤治疗中的功效。然而，基于 ICI 的治疗方案的肺毒性风险仍然未知。我们检索了2015年1月至2021年12月期间的多个数据库和临床试验网站，总结了癌症患者基于ICI的治疗的肺毒性概况和风险排名。我们纳入了一项 III 期随机临床试验 (RCT)，其中治疗组接受了至少一次 ICI 治疗并经历了肺部不良事件 (PAE)。我们的研究包括 104 项随机对照试验，发现程序性死亡 1 (PD-1) 化疗和 PD-1 细胞毒性 T 淋巴细胞相关抗原中 1-2 级和 3-5 级治疗相关 PAE (Tr-PAE) 的发生率最高4 (CTLA-4)，分别。 1-2级和3-5级免疫介导的PAEs（Im-PAEs）的首次发生率分别是PD1 CTLA-4化疗和PD-L1 CTLA4。细胞毒性T淋巴细胞相关抗原4化疗方案和PD-L1靶向治疗药物（TTD）化疗方案发生1-2级和3-5级Tr-PAE的风险最高。程序性死亡-L1 CTLA-4 比 PD-L1 具有更高的 3-5 级 Tr-PAE 风险。纳武单抗和阿替利珠单抗高剂量组和低剂量组发生 1-2 级肺毒性的风险存在显着差异。 Nivolumab 和 atezolizumab 诱导剂量依赖性 1-2 级肺毒性。在单药治疗方案中，PD-1 显示出最大的 1-2 级肺毒性。程序性死亡-L1 TTD 化疗在联合治疗中表现出最大的 3-5 级肺毒性。 PD-L1 TTD 化疗与 3-5 级 Tr-PAE 的较高风险相关，而 Im-PAE 的风险较低。我们建议采用有针对性的方法来管理 PAE。© 2023。作者获得 Springer Nature Switzerland AG 的独家许可。

Immune checkpoint inhibitors (ICIs) have shown efficacy in tumor therapy. However, the risk of pulmonary toxicity from ICI-based treatment regimens remains unknown. We searched multiple databases and clinical trial websites from January 2015 to December 2021 and summarized the pulmonary toxicity profile and risk ranking of ICI-based treatments in cancer patients. We included a Phase III randomized clinical trial (RCT) in which the treatment group received at least one ICI and experienced pulmonary adverse events (PAEs). Our study, which included 104 RCTs, found the highest incidence of grades 1-2 and 3-5 treatment-associated PAEs (Tr-PAEs) in programmed death 1 (PD-1)+ chemotherapy and PD-1+ cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), respectively. The first incidence rates of grades 1-2 and 3-5 immune-mediated PAEs (Im-PAEs) were PD1+CTLA-4+ chemotherapy and PD-L1 + CTLA4, respectively. Cytotoxic T lymphocyte-associated antigen 4 + chemotherapy regimen and PD-L1+ targeted therapy drug (TTD)+ chemotherapy regimen had the highest risk of developing grades 1-2 and 3-5 Tr-PAEs. Programmed death-L1+ CTLA-4 has a higher risk of grade 3-5 Tr-PAEs than PD-L1. The risk of grade 1-2 pulmonary toxicity was significantly different in the high-dose and low-dose groups of nivolumab and atezolizumab. Nivolumab and atezolizumab induced dose-dependent grade 1-2 pulmonary toxicity. Among single-agent regimens, PD-1 showed the greatest grade 1-2 pulmonary toxicity. Programmed death-L1+ TTD+ chemotherapy showed the greatest grade 3-5 pulmonary toxicity in combination therapy. PD-L1+ TTD+ chemotherapy was associated with a higher risk of grade 3-5 Tr-PAEs and a lower risk of Im-PAEs. We recommend a targeted approach to managing PAE.© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.