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Viral Associated Cancers and Disorders / Pneumonia and Respiratory Infections · Journal article
Respiratory Research · September 4, 2026
Well-designed and adequately powered for the question it asks.
This nationwide retrospective cohort study demonstrates that immune checkpoint inhibitor therapy in lung cancer patients is associated with a 2–3 fold increased risk of Pneumocystis jirovecii pneumonia compared with conventional chemotherapy, with consistent effects across multiple statistical models and clinically relevant subgroups. The association is robust and appears specific to certain ICI agents (durvalumab, pembrolizumab, atezolizumab) but not nivolumab.
Retrospective cohort study with propensity score matching. Patients newly diagnosed with lung cancer who initiated conventional cytotoxic chemotherapy or immune checkpoint inhibitor therapy between 2017 and 2022 in Korea.. Intervention: Immune checkpoint inhibitor therapy (atezolizumab, pembrolizumab, durvalumab, or nivolumab). Compared with: Conventional cytotoxic chemotherapy. n = 26,852. Korea (nationwide claims data).
ICI group had 66 PJP events vs 27 in chemotherapy group (incidence rates 7.77 vs 3.35 per 1,000 person-years) Adjusted incidence rate ratio 2.26 (95% CI 1.46–3.59) for ICI versus chemotherapy Adjusted hazard ratio 2.83 (95% CI 1.81–4.44) and adjusted subdistribution hazard ratio 2.63 (95% CI 1.68–4.12)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should maintain heightened vigilance for Pneumocystis jirovecii pneumonia in lung cancer patients receiving ICIs, particularly durvalumab, pembrolizumab, and atezolizumab. Given the high mortality of untreated PJP, enhanced monitoring and a lower threshold for diagnosis may be warranted in this population.
Rigorous nationwide retrospective cohort study with propensity score matching, large sample size, and consistent effect across multiple analytical approaches and subgroups, establishing a clinically significant increased risk of PJP with ICIs in lung cancer.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should maintain heightened vigilance for Pneumocystis jirovecii pneumonia in lung cancer patients receiving ICIs, particularly durvalumab, pembrolizumab, and atezolizumab. Given the high mortality of untreated PJP, enhanced monitoring and a lower threshold for diagnosis may be warranted in this population.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Although immune checkpoint inhibitors (ICIs) have led to a fundamental shift in lung cancer treatment, evidence regarding infections remains limited. Pneumocystis jirovecii pneumonia (PJP) is a rare but life-threatening opportunistic infection with high mortality if undiagnosed or untreated, making its risk assessment clinically critical. This study aimed to provide population-based comparative evidence on the risk of PJP between ICI therapy and conventional cytotoxic chemotherapy (CC) in patients with lung cancer. Using the Korean nationwide claims data, we conducted a retrospective cohort study of patients newly diagnosed with lung cancer who initiated CC or ICI therapy between 2017 and 2022. After propensity score matching, incidence rate ratios (IRRs), Cox hazard ratios (HRs), and Fine-Gray subdistribution HRs (sHRs) were estimated. Sensitivity analyses were performed across clinically relevant subgroups, including those defined by advanced stage, surgical resection, radiotherapy, treatment line, ICI monotherapy, and systemic corticosteroid use. Additionally, risk patterns across specific ICI agents, including atezolizumab, pembrolizumab, durvalumab, and nivolumab, were evaluated in an exploratory analysis. After matching, 13,426 patients were included in each group. During follow-up, 27 and 66 PJP events occurred in the CC and ICI groups, respectively, corresponding to IRs of 3.35 and 7.77 per 1,000 person-years. ICI therapy was associated with a significantly higher risk of PJP (adjusted IRR 2.26, 95% CI 1.46–3.59; adjusted HR 2.83, 95% CI 1.81–4.44; adjusted sHR 2.63, 95% CI 1.68–4.12). In the exploratory analysis, significantly elevated IRRs, HRs, and sHRs were observed for durvalumab, pembrolizumab, and atezolizumab, while no clear association was observed for nivolumab because of the limited number of events. This association remained robust and consistent across various clinical contexts including cohorts defined by disease stage, treatment line, the use of monotherapy, and patients without systemic steroid exposure. ICI therapy is associated with a significantly increased risk of PJP compared with CC in patients with lung cancer. Given the potential severity of PJP, enhanced clinical vigilance is warranted during ICI treatment.
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