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Abstract

Prospective Evaluation of Pulmonary Function Decline in Resected NSCLC Patients Receiving Adjuvant Pembrolizumab: A Single-Arm Observational Study †

by
Claire Seymour
1,
Olexiy Aseyev
2,3,* and
Birubi Biman
3,4
1
Clinical Research Services, Thunder Bay Regional Health Research Institute, Thunder Bay, ON P7B 6V4, Canada
2
Regional Cancer Centre, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON P7B 6V4, Canada
3
Division of Clinical Sciences, Northern Ontario School of Medicine University, Thunder Bay, ON P7B 5E1, Canada
4
Internal Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON P7B 6V4, Canada
*
Author to whom correspondence should be addressed.
†
Presented at the Internal Medicine Scientific Meeting of Northern Constellations 2026, 30 April–2 May 2026, Toronto, ON, Canada.
Proceedings 2026, 143(1), 3; https://doi.org/10.3390/proceedings2026143003
Published: 28 May 2026
Versions Notes

Background: Adjuvant pembrolizumab improves disease-free survival in resected stage IB–IIIA non-small-cell lung cancer (NSCLC); however, immune-related pneumonitis remains a clinically significant toxicity. Subclinical interstitial lung disease (ILD) and early pulmonary function decline may precede symptomatic pneumonitis but are not routinely monitored.
Purpose: To determine the prevalence of subclinical ILD and early pneumonitis in patients with resected NSCLC receiving adjuvant pembrolizumab, and to evaluate whether serial pulmonary function tests (PFTs) can serve as early detection markers.
Methods: This prospective, single-arm observational study enrols patients with completely resected stage IB-IIIA NSCLC receiving standard-of-care adjacent pembrolizumab (up to 18 cycles). PFTs including FEV1, FVC, and DLCO are performed at baseline, 6 weeks, 12 weeks, 24 weeks, and 51 weeks. Significant decline is defined as ≥10% reduction in FVC or ≥15% reduction in DLCO. Inflammatory biomarkers (CRP, IL-6, IL-8, TNF-α, neutrophil-to-lymphocyte ratio, eosinophil count) and patient-reported outcomes (EORTC QLQ-C30; dyspnoea scales) are collected longitudinally. Mixed-effects models will evaluate trends over time, and logistic regression will identify predictors of pneumonitis.
Results (Work in Progress): Enrolment is ongoing. Preliminary observations suggest measurable variability in DLCO during early treatment cycles, with some patients demonstrating asymptomatic declines warranting closer surveillance. Correlative biomarker analyses are underway.
Conclusions: This study aims to clarify the prevalence and trajectory of subclinical pulmonary toxicity during adjuvant immunotherapy. If serial PFT monitoring identifies early lung injury prior to symptomatic pneumonitis, this strategy could support proactive intervention and improve the safety profile of curative-intent immunotherapy.

Author Contributions

Conceptualization, O.A. and B.B.; methodology, O.A. and B.B.; writing—original draft preparation, O.A., B.B. and C.S.; writing—review and editing, C.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study has been approved by the Research Ethics Board of the Thunder Bay Regional Health Sciences Centre (protocol code 100341, approved 19 December 2025).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets presented in this article are not readily available because the data are part of an ongoing study. Requests to access the datasets should be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

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MDPI and ACS Style

Seymour, C.; Aseyev, O.; Biman, B. Prospective Evaluation of Pulmonary Function Decline in Resected NSCLC Patients Receiving Adjuvant Pembrolizumab: A Single-Arm Observational Study. Proceedings 2026, 143, 3. https://doi.org/10.3390/proceedings2026143003

AMA Style

Seymour C, Aseyev O, Biman B. Prospective Evaluation of Pulmonary Function Decline in Resected NSCLC Patients Receiving Adjuvant Pembrolizumab: A Single-Arm Observational Study. Proceedings. 2026; 143(1):3. https://doi.org/10.3390/proceedings2026143003

Chicago/Turabian Style

Seymour, Claire, Olexiy Aseyev, and Birubi Biman. 2026. "Prospective Evaluation of Pulmonary Function Decline in Resected NSCLC Patients Receiving Adjuvant Pembrolizumab: A Single-Arm Observational Study" Proceedings 143, no. 1: 3. https://doi.org/10.3390/proceedings2026143003

APA Style

Seymour, C., Aseyev, O., & Biman, B. (2026). Prospective Evaluation of Pulmonary Function Decline in Resected NSCLC Patients Receiving Adjuvant Pembrolizumab: A Single-Arm Observational Study. Proceedings, 143(1), 3. https://doi.org/10.3390/proceedings2026143003

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