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Otoshi R, Ikeda S, Kaneko T, Sagawa S, Yamada C, Kumagai K, Moriuchi A, Sekine A, Baba T, Ogura T. Treatment Strategies for Non-Small-Cell Lung Cancer with Comorbid Respiratory Disease; Interstitial Pneumonia, Chronic Obstructive Pulmonary Disease, and Tuberculosis. Cancers (Basel) 2024; 16:1734. [PMID: 38730686 PMCID: PMC11083871 DOI: 10.3390/cancers16091734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) patients are often complicated by other respiratory diseases, including interstitial pneumonia (IP), chronic obstructive pulmonary disease (COPD), and pulmonary tuberculosis (TB), and the management of which can be problematic. NSCLC patients with IP sometimes develop fatal acute exacerbation induced by pharmacotherapy, and the establishment of a safe treatment strategy is desirable. For advanced NSCLC with IP, carboplatin plus nanoparticle albumin-bound paclitaxel is a relatively safe and effective first-line treatment option. Although the safety of immune checkpoint inhibitors (ICIs) for these populations remains controversial, ICIs have the potential to provide long-term survival. The severity of COPD is an important prognostic factor in NSCLC patients. Although COPD complications do not necessarily limit treatment options, it is important to select drugs with fewer side effects on the heart and blood vessels as well as the lungs. Active TB is complicated by 2-5% of NSCLC cases during their disease course. Since pharmacotherapy, especially ICIs, reportedly induces the development of TB, the possibility of developing TB should always be kept in mind during NSCLC treatment. To date, there is no coherent review article on NSCLC with these pulmonary complications. This review article summarizes the current evidence and discusses future prospects for treatment strategies for NSCLC patients complicated with IP, severe COPD, and TB.
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Affiliation(s)
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-higashi, Kanazawa-ku, Yokohama 236-0051, Japan; (R.O.); (T.K.); (S.S.); (C.Y.); (K.K.); (A.M.); (A.S.); (T.B.); (T.O.)
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Hanibuchi M, Ogino H, Sato S, Nishioka Y. Current pharmacotherapies for advanced lung cancer with pre-existing interstitial lung disease : A literature review and future perspectives. THE JOURNAL OF MEDICAL INVESTIGATION 2024; 71:9-22. [PMID: 38735730 DOI: 10.2152/jmi.71.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Patients with interstitial lung disease (ILD), especially those with idiopathic pulmonary fibrosis, are at increased risk of developing lung cancer (LC). Pharmacotherapy for advanced LC has dramatically progressed in recent years;however, management of LC with pre-existing ILD (LC-ILD) is challenging due to serious concerns about the risk of acute exacerbation of ILD (AE-ILD). As patients with LC-ILD have been excluded from most prospective clinical trials of advanced LC, optimal pharmacotherapy remains to be elucidated. Although the antitumor activity of first-line platinum-based cytotoxic chemotherapy appears to be similar in advanced LC patients with or without ILD, its impact on the survival of patients with LC-ILD is limited. Immune checkpoint inhibitors may hold promise for long-term survival, but many challenges remain, including safety and appropriate patient selection. Further understanding the predictive factors for AE-ILD after receiving pharmacotherapy in LC-ILD may lead to appropriate patient selection and lower treatment risk. The aim of this review was to summarize the current evidence related to pharmacotherapy for advanced LC-ILD and discuss emerging areas of research. J. Med. Invest. 71 : 9-22, February, 2024.
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Affiliation(s)
- Masaki Hanibuchi
- Department of Community Medicine for Respirology, Hematology, and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Seidai Sato
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Shimizu Y, Koike T, Hasebe T, Nakamura M, Goto T, Toyabe SI, Tsuchida M. Surgical Treatment Outcomes of Patients with Non-Small Cell Lung Cancer and Lymph Node Metastases. Cancers (Basel) 2023; 15:3098. [PMID: 37370708 DOI: 10.3390/cancers15123098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to investigate the appropriate subgroups for surgery and adjuvant chemotherapy in patients with non-small-cell lung cancer (NSCLC) and nodal metastases. We retrospectively reviewed 210 patients with NSCLC and nodal metastases who underwent surgery and examined the risk factors for poor overall survival (OS) and recurrence-free probability (RFP) using multivariate Cox proportional hazards analysis. Pathological N1 and N2 were observed in 114 (52.4%) and 96 (47.6%) patients, respectively. A single positive node was identified in 102 patients (48.6%), and multiple nodes were identified in 108 (51.4%). Multivariate analysis revealed that vital capacity < 80% (hazard ratio [HR]: 2.678, 95% confidence interval [CI]: 1.483-4.837), radiological usual interstitial pneumonia pattern (HR: 2.321, 95% CI: 1.506-3.576), tumor size > 4.0 cm (HR: 1.534, 95% CI: 1.035-2.133), and multiple-node metastases (HR: 2.283, 95% CI: 1.517-3.955) were significant independent risk factors for poor OS. Tumor size > 4.0 cm (HR: 1.780, 95% CI: 1.237-2.562), lymphatic permeation (HR: 1.525, 95% CI: 1.053-2.207), and multiple lymph node metastases (HR: 2.858, 95% CI: 1.933-4.226) were significant independent risk factors for recurrence. In patients with squamous cell carcinoma (n = 93), there were no significant differences in OS or RFP between those who received platinum-based adjuvant chemotherapy (n = 25) and those who did not (n = 68), at p = 0.690 and p = 0.292, respectively. Multiple-node metastases were independent predictors of poor OS and recurrence. Patients with NSCLC and single-node metastases should be considered for surgery despite N2 disease. Additional treatment with platinum-based adjuvant chemotherapy may be expected, especially in patients with squamous cell carcinoma.
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Affiliation(s)
- Yuki Shimizu
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Toshiki Hasebe
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Masaya Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Tatsuya Goto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University, Niigata 951-8510, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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Risk of pneumonitis in non-small cell lung cancer patients with preexisting interstitial lung diseases treated with immune checkpoint inhibitors: a nationwide retrospective cohort study. Cancer Immunol Immunother 2023; 72:591-598. [PMID: 35994088 DOI: 10.1007/s00262-022-03281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Chemotherapy for non-small cell lung cancer (NSCLC) patients with preexisting interstitial lung diseases (ILDs) increases the risk of developing pneumonitis. However, the association between pneumonitis and immune checkpoint inhibitors (ICIs) and related factors remains unclear. METHODS We conducted a retrospective cohort study using a nationwide inpatient database. We included patients (aged ≥ 20 years) newly diagnosed with ILD and NSCLC and who started chemotherapy (ICIs or conventional chemotherapy) between January 2016 and December 2019. The primary endpoint was the onset of pneumonitis. We estimated the cumulative incidence function of pneumonitis and compared it with patients taking ICIs and patients receiving conventional chemotherapy using Gray's test. We calculated the subdistribution hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of pneumonitis using Fine and Gray's model to adjust for sex, age, smoking status, histology of NSCLC, surgical history, and medical histories, considering death as the competing risk. RESULTS We identified 1177 patients (mean age 72 years, 13.8% female), of which 328 and 849 were in the ICI and conventional chemotherapy groups, respectively. There was no significant difference in the cumulative incidence function of pneumonitis between the two groups (p = 0.868). The adjusted subdistribution HR for the incidence of pneumonitis was 1.08 (95% CI: 0.74-1.57). Age (≥ 65 years) (HR: 1.86, 95% CI: 1.11-3.10) and smoking history (HR: 2.04, 95% CI: 1.02-4.11) were associated with developing pneumonitis. CONCLUSION The risk of developing pneumonitis with ICIs for NSCLC patients with preexisting ILD was similar to that with conventional chemotherapy.
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Azuma Y, Sakamoto S, Homma S, Sano A, Sakai T, Koezuka S, Otsuka H, Tochigi N, Kishi K, Iyoda A. Impact of accurate diagnosis of interstitial lung diseases on postoperative outcomes in lung cancer. Gen Thorac Cardiovasc Surg 2023; 71:129-137. [PMID: 35999412 PMCID: PMC9886620 DOI: 10.1007/s11748-022-01868-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The prognostic impact of interstitial lung disease (ILD) subclassification based on both high-resolution computed tomography (HRCT) scan findings and histopathological findings is unknown. METHODS We retrospectively analyzed 104 patients who were diagnosed with clinical ILD according to HRCT scan findings and who underwent lung cancer surgery. Via an expert multidisciplinary discussion, we re-classified HRCT scan findings and validated the histopathological patterns of ILDs in lung specimens. RESULTS There were several mismatches between HRCT scan findings and histological patterns. Moreover, 87 (83.7%) and 6 (5.8%) patients were diagnosed with definitive ILD and pathological non-ILD, respectively. Finally, 82 patients with idiopathic interstitial pneumonias (IIPs) were divided into the idiopathic pulmonary fibrosis (IPF) (n = 61) group and the other group (n = 21). The 5-year overall survival rate of the IPF group was significantly lower than that of the other group (22.8% vs 67.9%; p = 0.011). Sub-classification of IIPs was found to be an independent prognostic factor for overall survival in patients with lung cancer. CONCLUSION An accurate diagnosis of IIPs/IPF according to both HRCT scan findings and histological patterns is important for providing an appropriate treatment among patients with lung cancer who presented with clinical ILD.
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Affiliation(s)
- Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Susumu Sakamoto
- Division of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Sakae Homma
- Division of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Kazuma Kishi
- Division of Respiratory Medicine, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
| | - Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan
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Funke-Chambour M, Kewalramani N, Machahua C, Poletti V, Wells AU, Cadranel J. Reply to: Pharmacotherapy for lung cancer with comorbid interstitial pneumonia: limited evidence requires appropriate evaluation. ERJ Open Res 2022; 8:00469-2022. [PMID: 36655227 PMCID: PMC9835994 DOI: 10.1183/23120541.00469-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/21/2023] Open
Abstract
The divergent views on lung cancer treatments in fibrosing lung patients reflect differences due to variable side-effect incidences in different countries and among ethnicities. International efforts are needed to better define treatment approaches. https://bit.ly/3DX40fq.
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Affiliation(s)
- Manuela Funke-Chambour
- Department for BioMedical Research DBMR, Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Manuela Funke-Chambour ()
| | - Namrata Kewalramani
- Department for BioMedical Research DBMR, Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlos Machahua
- Department for BioMedical Research DBMR, Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Venerino Poletti
- Department of Thoracic Diseases, “G.B. Morgagni” Hospita, Forlì, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES) University of Bologna, Bologna, Italy
| | - Athol U. Wells
- Royal Brompton and Harefield NHS Foundation Trust, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Jacques Cadranel
- Department of Pulmonary Medicine and Thoracic Oncology, Constitutive Reference Center of Rare Pulmonary Diseases, AP-HP, Hôpital Tenon and GRC04 Theranoscan, Sorbonne Université, Paris, France
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Otsubo K, Kishimoto J, Ando M, Kenmotsu H, Minegishi Y, Horinouchi H, Kato T, Ichihara E, Kondo M, Atagi S, Tamiya M, Ikeda S, Harada T, Takemoto S, Hayashi H, Nakatomi K, Kimura Y, Kondoh Y, Kusumoto M, Ichikado K, Yamamoto N, Nakagawa K, Nakanishi Y, Okamoto I. Nintedanib plus chemotherapy for nonsmall cell lung cancer with idiopathic pulmonary fibrosis: a randomised phase 3 trial. Eur Respir J 2022; 60:2200380. [PMID: 35361630 DOI: 10.1183/13993003.00380-2022] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease implicated as an independent risk factor for lung cancer. However, optimal treatment for advanced lung cancer with IPF remains to be established. We performed a randomised phase 3 trial (J-SONIC) to assess the efficacy and safety of nintedanib plus chemotherapy (experimental arm) compared with chemotherapy alone (standard-of-care arm) for advanced nonsmall cell lung cancer (NSCLC) with IPF. METHODS Chemotherapy-naïve advanced NSCLC patients with IPF were allocated to receive carboplatin (area under the curve of 6 on day 1) plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel) (100 mg·m-2 on days 1, 8 and 15) every 3 weeks with or without nintedanib (150 mg twice daily, daily). The primary end-point was exacerbation-free survival (EFS). RESULTS Between May 2017 and February 2020, 243 patients were enrolled. Median EFS was 14.6 months in the nintedanib plus chemotherapy group and 11.8 months in the chemotherapy group (hazard ratio (HR) 0.89, 90% CI 0.67-1.17; p=0.24), whereas median progression-free survival was 6.2 and 5.5 months, respectively (HR 0.68, 95% CI 0.50-0.92). Overall survival was improved by nintedanib in patients with nonsquamous histology (HR 0.61, 95% CI 0.40-0.93) and in those at GAP (gender-age-physiology) stage I (HR 0.61, 95% CI 0.38-0.98). Seven (2.9%) out of 240 patients experienced acute exacerbation during study treatment. CONCLUSIONS The primary end-point of the study was not met. However, carboplatin plus nab-paclitaxel was found to be effective and tolerable in advanced NSCLC patients with IPF. Moreover, nintedanib in combination with such chemotherapy improved overall survival in patients with nonsquamous histology.
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Affiliation(s)
- Kohei Otsubo
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Dept of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Masahiko Ando
- Dept of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Japan
| | - Yuji Minegishi
- Dept of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Dept of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Terufumi Kato
- Dept of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Eiki Ichihara
- Dept of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Masashi Kondo
- Dept of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shinji Atagi
- Dept of Thoracic Oncology, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Motohiro Tamiya
- Dept of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoshi Ikeda
- Dept of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Toshiyuki Harada
- Dept of Respiratory Medicine, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Shinnosuke Takemoto
- Dept of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hidetoshi Hayashi
- Dept of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Keita Nakatomi
- Division of Respiratory Medicine, Kyushu Central Hospital, Fukuoka, Japan
| | - Yuichiro Kimura
- Dept of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yasuhiro Kondoh
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Masahiko Kusumoto
- Dept of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Kazuhiko Nakagawa
- Dept of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Kitakyushu City Hospital Organization, Kitakyushu, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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[Research Progress on the Pathogenesis of Lung Cancer Associated with
Idiopathic Pulmonary Fibrosis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:811-818. [PMID: 36419395 PMCID: PMC9720683 DOI: 10.3779/j.issn.1009-3419.2022.101.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease (ILD) of unknown causes, which is characterized by pulmonary fibrosis. The median survival period after diagnosis is about 2-4 years. In recent years, the incidence rate of lung cancer associated with IPF (IPF-LC) is increasing, and the prognosis is worse than that of IPF alone. Pulmonary fibrosis may be closely associated with the occurrence and development of lung cancer. Although the pathogenesis of IPF-LC is still unclear, the current research shows that there are similarities between the pathogenesis of these two diseases at molecular and cellular levels. At present, the research on the cellular and molecular mechanism of lung cancer related to pulmonary fibrosis has become the focus of researchers' attention. This article reviews the related literature, focusing on the latest status of the cellular and molecular mechanisms and treatment of IPF-LC, hoping to help clinicians understand IPF-LC.
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Perrotta F, Chino V, Allocca V, D’Agnano V, Bortolotto C, Bianco A, Corsico AG, Stella GM. Idiopathic pulmonary fibrosis and lung cancer: targeting the complexity of the pharmacological interconnection. Expert Rev Respir Med 2022; 16:1043-1055. [DOI: 10.1080/17476348.2022.2145948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Fabio Perrotta
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Vittorio Chino
- - University of Pavia Medical School, 27100 Pavia, Italy
- - Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Valentino Allocca
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Vito D’Agnano
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Chandra Bortolotto
- - Dept. of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia Medical School, Pavia, Italy
- - Department of Intensive Medicine, Unit of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Bianco
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Angelo Guido Corsico
- - Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
- - Dept. of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, Pavia, Italy
| | - Giulia Maria Stella
- - Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
- - Dept. of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, Pavia, Italy
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10
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Otsuka K, Nokihara H, Mitsuhashi A, Ozaki R, Yabuki Y, Yoneda H, Ogino H, Nishioka Y. Efficacy and safety of second-line chemotherapy for patients with advanced non-small cell lung cancer complicated by interstitial lung disease. Thorac Cancer 2022; 13:2978-2984. [PMID: 36106507 PMCID: PMC9626311 DOI: 10.1111/1759-7714.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Treatment of non-small cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) is limited because of the risk of its acute exacerbation (AE). Furthermore, the efficacy and safety of second-line chemotherapy for these patients is unclear. METHODS To investigate the efficacy and safety of second-line chemotherapy for NSCLC patients with ILD, we retrospectively reviewed patients who were treated at our institute between April 2010 and December 2018. RESULTS Thirty-five patients received two or more regimens. Thirty-four patients were male and the median age at the initiation of second-line chemotherapy was 70 years. Almost all patients had a smoking history. Fourteen patients had adenocarcinoma and 15 had squamous cell carcinoma histology. Stages III and IV were observed in 20 and 11 patients, respectively. With respect to the type of ILD, 12 patients had usual interstitial pneumonia (UIP). The overall response rate and disease control rate were 11.4 and 68.6%, respectively. The median progression-free and median overall survival were 4.1 and 6.4 months, respectively. The AE of ILD was observed in eight patients, five of whom died. UIP and low percentage vital capacity were detected as significant risk factors for the AE of ILD. CONCLUSION Second-line chemotherapy among patients with NSCLC complicated by ILD showed a certain effectiveness, but some patients experienced the AE of ILD, which may lead to death. The risk of the AE of ILD must be considered especially for patients with UIP and low percentage VC.
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Affiliation(s)
- Kenji Otsuka
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan,Respiratory Medicine, Center Hospital of the National Center for Global Health and MedicineTokyoJapan
| | - Atsushi Mitsuhashi
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Ryohiko Ozaki
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Yohei Yabuki
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Hiroto Yoneda
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
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Sekine A, Matama G, Hagiwara E, Tabata E, Ikeda S, Oda T, Okuda R, Kitamura H, Baba T, Satoh H, Misumi T, Komatsu S, Iwasawa T, Ogura T. Disease activity of lung cancer at the time of acute exacerbation of interstitial lung disease during cytotoxic chemotherapy. Thorac Cancer 2022; 13:2443-2449. [PMID: 35840339 PMCID: PMC9436679 DOI: 10.1111/1759-7714.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background The prognosis of lung cancer patients with interstitial lung disease (ILD) is poor, and acute exacerbation (AE) of ILD can occur during chemotherapy as a fatal adverse event. Although AE‐ILD development is correlated with various factors, no reports are investigating the disease activity of lung cancer at the time of AE‐ILD development. Methods All consecutive lung cancer patients with ILD who developed chemotherapy‐related AE‐ILD within 28 days after the last administration of cytotoxic chemotherapy between 2011 and 2020 were retrospectively reviewed. Results Among 206 lung cancer patients with ILD who were treated with cytotoxic chemotherapy, 30 patients were included. The median age was 72 years and all patients were men with smoking history. Usual interstitial pneumonia (UIP) and non‐UIP patterns of ILD was observed in 17 and 13 patients. Most of AE‐ILD occurred during second‐ or later‐line (22/30, 73.3%) and developed within first or second courses during chemotherapy (19/30, 63.3%). Regarding tumor response to chemotherapy at AE‐ILD development, majority of patients (18 patients, 60.0%) experienced progressive disease and only one patient (3.3%) experienced a partial response. Notably, 27 patients (90.0%) did not exhibit any tumor shrinkage of the thoracic lesions. Conclusion Lung cancer was uncontrolled with cytotoxic chemotherapy at the time of AE‐ILD development. Although AE‐ILD during chemotherapy has been generally discussed in terms of drug‐specific adverse effects, uncontrolled lung cancer may be also correlated with AE‐ILD development.
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Affiliation(s)
- Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Goushi Matama
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Erina Tabata
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Ryo Okuda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Hiroaki Satoh
- Department of Internal Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
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Ikeda N, Arai R, Soda S, Inoue T, Uchida N, Nakamura Y, Masawa M, Kushima Y, Okutomi H, Takemasa A, Shimizu Y, Niho S. Carboplatin plus nab-paclitaxel for recurrent small cell lung cancer: A phase II study. Thorac Cancer 2022; 13:1342-1348. [PMID: 35318811 PMCID: PMC9058313 DOI: 10.1111/1759-7714.14394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 01/22/2023] Open
Abstract
Background We conducted a phase II study of carboplatin plus nab‐paclitaxel for the treatment of small cell lung cancer (SCLC) after the failure of a prior standard chemotherapy containing platinum, etoposide, irinotecan, and amrubicin if indicated. Patients with interstitial pneumonia complications were included in the study. Methods Patients received 100 mg/m2 of nab‐paclitaxel weekly (on days 1, 8, and 15) and an AUC 5 of carboplatin on day 1. The study treatment was repeated every 3 weeks until disease progression or the appearance of unacceptable toxicities. The primary endpoint was the objective response rate. Results A total of 21 patients were enrolled, all of whom were eligible for inclusion in the analysis. Twelve patients had pre‐existing interstitial pneumonia. The overall response rate was 19.0% (90% confidence interval [CI]: 6.8%–38.4%). The lower limit of the 90% CI for the response rate did not exceed the prespecified threshold value of 10%. Among the 12 patients with pre‐existing interstitial pneumonia, the response rate was 25%. The median progression‐free survival time was 2.5 months (95% CI: 1.5–3.4 months), and the median survival time was 5.1 months (95% CI: 2.1–8.1 months). Two patients developed interstitial lung disease; both of these patients had pre‐existing interstitial pneumonia. One of the patients died from interstitial lung disease. Conclusion Combination chemotherapy with carboplatin plus nab‐paclitaxel for recurrent SCLC had a modest activity, although the primary study endpoint was not met. Further investigation of this regimen for patients with recurrent SCLC and interstitial pneumonia is warranted.
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Affiliation(s)
- Naoya Ikeda
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Ryo Arai
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Sayo Soda
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Takashi Inoue
- Department of Respiratory Medicine, Sano Kosei General Hospital, Tochigi, Japan
| | - Nobuhiko Uchida
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yusuke Nakamura
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Meitetsu Masawa
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yoshitomo Kushima
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hiroaki Okutomi
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akihiro Takemasa
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasuo Shimizu
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Seiji Niho
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
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13
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Igawa S, Yokoba M, Takakura A, Hosotani S, Nakahara Y, Sato T, Mitsufuji H, Sasaki J, Naoki K. Real-world evaluation of second line chemotherapy for patients with advanced non-small cell lung cancer harboring preexisting interstitial lung disease. Invest New Drugs 2022; 40:182-189. [PMID: 34415485 DOI: 10.1007/s10637-021-01162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The optimal second and subsequent lines of chemotherapy for patients with non-small cell lung cancer (NSCLC) who have preexisting interstitial lung disease (ILD) are unclear. Hence, we examined the clinical efficacy and safety of second-line chemotherapy in such patients, including any exacerbation of preexisting ILD. METHODS The medical records of patients with NSCLC and preexisting ILD who received both first- and second-line chemotherapy were retrospectively reviewed. RESULTS Twenty-four patients with a median age of 71 years who were treated between April 2013 and March 2021 were included. The response rate after second-line chemotherapy with S-1 (n = 13), docetaxel (n = 8), pemetrexed (n = 2), or docetaxel plus ramucirumab (n = 1) was 12.5%, with a median progression-free survival (2nd line PFS) of 3.8 months. The overall survival from a start of first-line chemotherapy (1st line OS) and post-progression survival (PPS) post-first-line chemotherapy were 18.7 and 9.7 months, respectively. Spearman rank correlation and linear regression analyses showed that PPS was strongly correlated with 1st line OS (R = 0.85, P < 0.00001). Importantly, the 2nd line PFS was also significantly correlated with 1st line OS (R = 0.71, P = 0.0001). While second-line chemotherapy-related acute exacerbation of ILD was observed in 7 patients (29.2%), there were no treatment-related fatalities. Conslusions. Second-line chemotherapy has a strong positive impact on the OS of patients with NSCLC who have preexisting ILD. Given the findings of this study, second-line chemotherapy may be valuable in terms of prolonging long-term OS.
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Affiliation(s)
- Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan.
| | - Masanori Yokoba
- School of Allied Health Sciences, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan
| | - Akira Takakura
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Shinji Hosotani
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Takashi Sato
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Hisashi Mitsufuji
- Kitasato University School of Nursing, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0329, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
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14
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Takahara Y, Tanaka T, Ishige Y, Shionoya I, Yamamura K, Sakuma T, Nishiki K, Nakase K, Nojiri M, Kato R, Shinomiya S, Fujimoto Y, Oikawa T, Mizuno S. Risk factors for acute exacerbation in lung cancer complicated by interstitial lung disease with slight reticular shadows. Thorac Cancer 2021; 12:2758-2766. [PMID: 34409749 PMCID: PMC8520810 DOI: 10.1111/1759-7714.14121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The risk of cancer treatment-related acute exacerbation (AE) in patients with lung cancer and mild interstitial lung disease (ILD) on imaging, classified as indeterminate for usual interstitial pneumonia (UIP), has not previously been clarified. METHODS We retrospectively reviewed the clinical records of 27 patients with lung cancer and ILD who were diagnosed and treated from April 2016 to March 2021. RESULTS Among the 27 patients, 21 were classified as indeterminate for UIP and six as UIP/probable UIP; furthermore, 10 (46.6%) and three (50%) patients from each group, respectively, developed treatment-related AEs. No significant difference was observed regarding the incidence of AEs between the two groups. However, significantly more patients in the AE group received immune checkpoint inhibitors (ICIs) compared to the non-AE group (p = 0.021). Multivariate analysis revealed that the use of ICIs was a significant independent risk factor for treatment-related AEs. CONCLUSIONS Lung cancer patients with mild ILD suggestive of indeterminate for UIP and UIP patterns are at an increased risk for treatment-related AEs. Furthermore, ICI use is an independent risk factor for AEs in patients with lung cancer complicated by ILD, and ICIs should be used with great caution.
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Affiliation(s)
- Yutaka Takahara
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Takuya Tanaka
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Yoko Ishige
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Ikuyo Shionoya
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Kouichi Yamamura
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Takashi Sakuma
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Kazuaki Nishiki
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Keisuke Nakase
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Masafumi Nojiri
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Ryo Kato
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Shohei Shinomiya
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Yuki Fujimoto
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Taku Oikawa
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
| | - Shiro Mizuno
- Department of Respiratory MedicineKanazawa Medical UniversityIshikawaJapan
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15
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Ikeda S, Kato T, Kenmotsu H, Sekine A, Baba T, Ogura T. Current Treatment Strategies for Non-Small-Cell Lung Cancer with Comorbid Interstitial Pneumonia. Cancers (Basel) 2021; 13:3979. [PMID: 34439135 PMCID: PMC8393888 DOI: 10.3390/cancers13163979] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Of patients with advanced non-small-cell lung cancer (NSCLC), 5-10% have interstitial pneumonia (IP) at the time of diagnosis. To avoid fatal acute exacerbations of pre-existing IP, appropriate patient selection and low-risk treatment choices are warranted. Risk factors for acute exacerbation of pre-existing IP with cytotoxic drugs include honeycomb lungs on computed tomography (CT) and low forced vital capacity, but risk factors with immune checkpoint inhibitors (ICIs) have not been fully investigated. For advanced or recurrent NSCLC with comorbid IP, carboplatin plus nanoparticle albumin-bound paclitaxel is the standard of care for first-line treatment, but second-line or later treatment has not been established. ICI holds great promise for long-term survival, but many challenges remain, including safety and appropriate patient selection. Since the indications for pharmacotherapy and radiotherapy for NSCLC with comorbid IP are quite limited, surgical resection should be considered as much as possible for patients with operable stages. A scoring system has been reported to predict the risk of postoperative acute exacerbation of pre-existing IP, but perioperative treatment has not been established. In the future, it is necessary to accumulate more cases and conduct further research, not only in Japan but also worldwide.
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Affiliation(s)
- Satoshi Ikeda
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, 6-16-1, Tomioka-higashi, Kanazawa-ku, Kanagawa 236-0051, Japan; (A.S.); (T.B.); (T.O.)
| | - Terufumi Kato
- Kanagawa Cancer Center, Department of Thoracic Oncology, 2-3-2, Nakao, Asahi-ku, Kanagawa 241-8515, Japan;
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan;
| | - Akimasa Sekine
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, 6-16-1, Tomioka-higashi, Kanazawa-ku, Kanagawa 236-0051, Japan; (A.S.); (T.B.); (T.O.)
| | - Tomohisa Baba
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, 6-16-1, Tomioka-higashi, Kanazawa-ku, Kanagawa 236-0051, Japan; (A.S.); (T.B.); (T.O.)
| | - Takashi Ogura
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, 6-16-1, Tomioka-higashi, Kanazawa-ku, Kanagawa 236-0051, Japan; (A.S.); (T.B.); (T.O.)
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16
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Kikuchi R, Takoi H, Tsuji T, Nagatomo Y, Tanaka A, Kinoshita H, Ono M, Ishiwari M, Toriyama K, Kono Y, Togashi Y, Yamaguchi K, Yoshimura A, Abe S. Glasgow prognostic score for prediction of chemotherapy-triggered acute exacerbation interstitial lung disease in patients with small cell lung cancer. Thorac Cancer 2021; 12:1681-1689. [PMID: 33939332 PMCID: PMC8169307 DOI: 10.1111/1759-7714.13900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Predicting the incidence of chemotherapy-triggered acute exacerbation of interstitial lung disease (AE-ILD) in patients with lung cancer is important because AE-ILD confers a poor prognosis. The Glasgow prognostic score (GPS), which is an inflammation-based index composed of serum levels of C-reactive protein and albumin, predicts prognosis in patients with small cell lung cancer (SCLC) without ILD. In this study, we investigated AE-ILD and survival outcome based on the GPS in patients with ILD associated with SCLC who were receiving chemotherapy. METHODS Medical records of patients who received platinum-based first-line chemotherapy between June 2010 and May 2019 were retrospectively reviewed to compare the incidence of AE-ILD and overall survival (OS) between GPS 0, 1, and 2. RESULTS Among our cohort of 31 patients, six (19.3%) experienced chemotherapy-triggered AE-ILD. The AE-ILD incidence increased from 9.5% to 25.0% and 50.0% with increase in GPS of 0, 1, and 2, respectively. Univariate and multivariate analyses revealed remarkable associations between GPS 2 and both AE-ILD (odds ratio for GPS 2, 18.69; p = 0.046) and prognosis (hazard ratio of GPS 2, 13.52; p = 0.002). Furthermore, median OS in the GPS 0, 1, and 2 groups was 16.2, 9.8, and 7.1 months, respectively (p < 0.001). CONCLUSIONS Our results suggest that GPS 2 is both a predictor of risk of chemotherapy-triggered AE-ILD and a prognostic indicator in patients with ILD associated with SCLC. We propose that GPS may be used as a guide to distinguish chemotherapy-tolerant patients from those at high risk of AE-ILD.
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Affiliation(s)
- Ryota Kikuchi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Hiroyuki Takoi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Takao Tsuji
- Respiratory CenterOtsuki Municipal Central HospitalOtsuki‐shiJapan
| | - Yoko Nagatomo
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Akane Tanaka
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Hayato Kinoshita
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Mariko Ono
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Mayuko Ishiwari
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Kazutoshi Toriyama
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Yuta Kono
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Yuki Togashi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Kazuhiro Yamaguchi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Akinobu Yoshimura
- Department of Clinical OncologyTokyo Medical University HospitalTokyoJapan
| | - Shinji Abe
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
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17
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Xiaohong X, Liqiang W, Na L, Xinqing L, Yinyin Q, Ming L, Ming O, Qian H, Qun L, Shiyue L, Chunyan L, Xiaoqian W, Shuanying Y, Wei H, Mei L, Ping W, Chengzhi Z. Management and Prognosis of Interstitial Lung Disease With Lung Cancer (ILD-LC): A Real-World Cohort From Three Medical Centers in China. Front Mol Biosci 2021; 8:660800. [PMID: 33869290 PMCID: PMC8044367 DOI: 10.3389/fmolb.2021.660800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/08/2021] [Indexed: 02/02/2023] Open
Abstract
Background and Objective Interstitial lung disease with lung cancer (ILD-LC) is rare and its management has not been fully described. This study aimed to investigate the management and prognosis of ILD-LC patients in China. Methods The present analysis is a retrospective real-world cohort study. Clinical data of ILD-LC patients were obtained from 3 hospitals in China. The overall survival (OS) of patients was analyzed. Univariate and multivariate regression analyses were performed. Results One hundred eighty-four ILD-LC patients included were biased toward male (85.3%), smokers (75.5%), idiopathic pulmonary fibrosis (IPF) (58.2%) patients with comorbidities (67.9%) and ECOG-PS score of 1 (65.2%). Most patients were advanced peripheral non-small cell lung cancer. The initial anti-cancer regimen for ILD-LC is mainly chemotherapy, and patients with early-stage LC prefer surgery. In the anti-cancer cohort, the number of ILD-LC patients who underwent the 2nd and 3rd or more anti-cancer regimens were 78 (55.7%) and 32 (22.8%), respectively. In the non-anticancer cohort, the median OS was 3.5 months. In the early-stage cohort, the median OS was 14.2 months in the systematic therapy group; however, the median OS was not reached in the surgery group. In the advanced-stage cohort with systematic therapy, the median OS was 7.2 months. Interstitial pneumonia (IIP) and anti-angiogenesis were associated with OS in the univariate analysis, whereas anti-angiogenesis was an independent protective factor for advanced LC with ILD. Conclusion Patients with ILD-LC have very poor prognosis. Appropriate anti-tumor treatment can prolong the survival time of patients who can tolerate it. Targeted therapy and immunotherapy are alternative treatments for LC patients with mild ILD. For ILD patients with advanced LC, antiangiogenic regimens significantly improve the prognosis of the disease.
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Affiliation(s)
- Xie Xiaohong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Wang Liqiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Li Na
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lin Xinqing
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Qin Yinyin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Liu Ming
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Ouyang Ming
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Han Qian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Luo Qun
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Li Shiyue
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Li Chunyan
- Department of Respiratory and Critical Care Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Wang Xiaoqian
- Department of Respiratory and Critical Care Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yang Shuanying
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huang Wei
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liu Mei
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wang Ping
- Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Zhou Chengzhi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
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18
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Kawamura S, Kubo T, Takada K, Sunami R, Okawa S, Iwamoto Y, Hirabae A, Taniguchi A, Maeda Y, Kiura K, Tabata M. A case of interstitial pneumonia associated with systemic sclerosis and primary peritoneal serous carcinoma successfully treated with cyclophosphamide. Int Cancer Conf J 2021; 10:197-200. [PMID: 34221831 DOI: 10.1007/s13691-021-00475-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/13/2021] [Indexed: 11/25/2022] Open
Abstract
A 62-year-old woman with edema and color changes in her fingers underwent computed tomography (CT); slight interstitial changes were detected in the lungs with multiple tumors in the anterior and hilar region of the liver. Based on the blood test findings, she was diagnosed with interstitial pneumonia associated with systemic sclerosis. Ultrasound-guided biopsy from the hepatic hilar lymph node revealed poorly differentiated serous adenocarcinoma cells. High serum CA-125 levels suggested primary peritoneal serous carcinoma (PPSC). Owing to increased interstitial shadows on chest CT images and worsening respiratory distress, intravenous cyclophosphamide and oral prednisolone treatment was started. The skin-related symptoms, respiratory distress, and interstitial shadows improved, and the tumor size reduced. Eighteen months later, the patient has had no exacerbation of interstitial pneumonia, and the PPSC is well controlled.
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Affiliation(s)
- Shunichi Kawamura
- Center for Graduate Medical Education, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Kenji Takada
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Ryota Sunami
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Sachi Okawa
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Yoshitaka Iwamoto
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
- General Internal Medicine, Okayama Medical Center, 1711-1, Tamasu, Okayama, 701-1192 Japan
| | - Atsuko Hirabae
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Akihiko Taniguchi
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Yoshinobu Maeda
- Hematology, Oncology and Respiratory Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Katsuyuki Kiura
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
| | - Masahiro Tabata
- Center for Clinical Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558 Japan
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19
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Kikuchi R, Takoi H, Tsuji T, Nagatomo Y, Tanaka A, Kinoshita H, Ono M, Ishiwari M, Toriyama K, Kono Y, Togashi Y, Yamaguchi K, Yoshimura A, Abe S. Glasgow Prognostic Score predicts chemotherapy-triggered acute exacerbation-interstitial lung disease in patients with non-small cell lung cancer. Thorac Cancer 2021; 12:667-675. [PMID: 33480111 PMCID: PMC7919129 DOI: 10.1111/1759-7714.13792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) in patients with non-small cell lung cancer (NSCLC) worsens the prognosis for overall survival (OS) due to chemotherapy-triggered acute exacerbation (AE)-ILD. The Glasgow Prognostic Score (GPS), which is based on serum C-reactive protein and albumin levels, has been suggested as a reliable prognostic tool for mortality in cancer patients, including NSCLC. In this study, we investigated whether GPS is a predictor for chemotherapy-triggered AE-ILD and the prognosis in patients with NSCLC and pre-existing ILD. METHODS We conducted a retrospective review on 56 NSCLC and ILD patients at our hospital who received platinum agent-based treatment as first-line chemotherapy between June 2010 and May 2019. We categorized these patients according to their GPS (0-2) and compared the incidence of chemotherapy-triggered AE-ILD and OS. RESULTS The GPS 0, 1, and 2 groups included 31, 16, and nine patients, respectively, out of 56. A total of 12 (21.4%) patients showed chemotherapy-triggered AE-ILD. The median OS was at 11.5 months (95% confidence interval: 8.0-15.1). The incidence of chemotherapy-triggered AE-ILD within the first year of chemotherapy in the GPS 0, 1, and 2 groups was three (9.6%), four (25.0%), and five (55.5%), and the median OS time was 16.9, 9.8 and 7.6 months, respectively. Univariate and multivariate analyses indicated that only GPS 2 could predict both chemotherapy-triggered AE-ILD and OS (P < 0.05). CONCLUSIONS GPS assessment of patients with NSCLC and pre-existing ILD is a valuable prognostic tool for predicting chemotherapy-triggered AE-ILD and OS. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: We found that GPS 2 was an independent risk factor for chemotherapy-triggered AE-ILD and prognosis in patients with ILD associated with NSCLC. WHAT THIS STUDY ADDS GPS may potentially enable the discrimination of patients tolerant of chemotherapy from those at an increased risk of AE-ILD and predict the prognosis in patients with NSCLC and ILD receiving chemotherapy.
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Affiliation(s)
- Ryota Kikuchi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Hiroyuki Takoi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Takao Tsuji
- Respiratory CenterOtsuki Municipal Central HospitalYamanashiJapan
| | - Yoko Nagatomo
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Akane Tanaka
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Hayato Kinoshita
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Mariko Ono
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Mayuko Ishiwari
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Kazutoshi Toriyama
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Yuta Kono
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Yuki Togashi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Kazuhiro Yamaguchi
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
| | - Akinobu Yoshimura
- Department of Clinical OncologyTokyo Medical University HospitalTokyoJapan
| | - Shinji Abe
- Department of Respiratory MedicineTokyo Medical University HospitalTokyoJapan
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20
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Yamamoto Y, Yano Y, Kuge T, Okabe F, Ishijima M, Uenami T, Kanazu M, Akazawa Y, Yamaguchi T, Mori M. Safety and effectiveness of pirfenidone combined with carboplatin-based chemotherapy in patients with idiopathic pulmonary fibrosis and non-small cell lung cancer: A retrospective cohort study. Thorac Cancer 2020; 11:3317-3325. [PMID: 32986306 PMCID: PMC7606001 DOI: 10.1111/1759-7714.13675] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background Pirfenidone is an antifibrotic agent that is potentially effective for the treatment of idiopathic pulmonary fibrosis (IPF). However, no study has reported on its prophylactic value against chemotherapy‐associated acute IPF exacerbations when combined with chemotherapy for non‐small cell lung cancer (NSCLC). The present study assessed the safety and effectiveness of pirfenidone combined with carboplatin‐based chemotherapy or immune checkpoint inhibitors (ICIs) in patients with IPF and NSCLC. Methods A total of 14 patients with IPF and NSCLC who received treatment from 2013 to 2019 were included. Patients were treated with pirfenidone combined with carboplatin and nanoparticle albumin‐bound paclitaxel or S‐1 as first‐line chemotherapy. After confirming disease progression, patients received cytotoxic agents or ICIs, including nivolumab and pembrolizumab. Pirfenidone was continued regardless of chemotherapy changes. Overall survival (OS) and progression‐free survival (PFS) for lung cancer and IPF were calculated. Moreover, the cumulative incidence of acute exacerbation of IPF (AE‐IPF) within one year was evaluated. Results Median PFS for lung cancer was 110 days (95% confidence interval [CI]: 57–199 days), while the median OS was 362 days (95% CI: 220–526 days). Moreover, PFS for IPF was 447 days (95% CI: 286–indeterminate days), and the cumulative incidence of AE‐IPF within one year was 18%. Notably, none of the patients developed AE‐IPF associated with first‐line chemotherapy. Among the included patients, four received ICIs, none of whom developed ICI‐associated AE‐IPF. Conclusions The present study found that pirfenidone combined with carboplatin‐based regimens or ICIs might be safe first‐line chemotherapy for patients with IPF and NSCLC. Key points Significant findings of the study No patients with IPF and NSCLC who received pirfenidone in combination with first‐line carboplatin‐based chemotherapy or late‐line ICIs developed acute IPF exacerbations.
What this study addsPirfenidone might have a prophylactic effect against chemotherapy‐associated AE‐IPF.
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Affiliation(s)
- Yuji Yamamoto
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Yukihiro Yano
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Tomoki Kuge
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Fukuko Okabe
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Mikako Ishijima
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Takeshi Uenami
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Masaki Kanazu
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Yuki Akazawa
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Toshihiko Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Masahide Mori
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
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21
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Terbuch A, Tiu C, Candilejo IM, Scaranti M, Curcean A, Bar D, Estevez Timon M, Ameratunga M, Ang JE, Ratoff J, Minchom AR, Banerji U, de Bono JS, Tunariu N, Lopez JS. Radiological Patterns of Drug-induced Interstitial Lung Disease (DILD) in Early-phase Oncology Clinical Trials. Clin Cancer Res 2020; 26:4805-4813. [PMID: 32332017 DOI: 10.1158/1078-0432.ccr-20-0454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Drug-induced interstitial lung disease (DILD) is a rare, but potentially fatal toxicity. Clinical and radiological features of DILD in the early experimental setting are poorly described. PATIENTS AND METHODS A total of 2,499 consecutive patients with advanced cancer on phase I clinical trials were included. DILD was identified by a dedicated radiologist and investigators, categorized per internationally recognized radiological patterns, and graded per Common Terminology Criteria for Adverse Events (CTCAE) and the Royal Marsden Hospital (RMH) DILD score. Clinical and radiological features of DILD were analyzed. RESULTS Sixty patients overall (2.4%) developed DILD. Median time to onset of DILD was 63 days (range, 14-336 days). A total of 45% of patients who developed DILD were clinically asymptomatic. Incidence was highest in patients receiving drug conjugates (7.4%), followed by inhibitors of the PI3K/AKT/mTOR pathway (3.9%). The most common pattern seen was hypersensitivity pneumonitis (33.3%), followed by nonspecific interstitial pneumonia (30%), and cryptogenic organizing pneumonia (26.7%). A higher DILD score [OR, 1.47, 95% confidence interval (CI), 1.19-1.81; P < 0.001] and the pattern of DILD (OR, 5.83 for acute interstitial pneumonia; 95% CI, 0.38-90.26; P = 0.002) were significantly associated with a higher CTCAE grading. The only predictive factor for an improvement in DILD was an interruption of treatment (OR, 0.05; 95% CI, 0.01-0.35; P = 0.01). CONCLUSIONS DILD in early-phase clinical trials is a toxicity of variable onset, with diverse clinical and radiological findings. Radiological findings precede clinical symptoms. The extent of the affected lung parenchyma, scored by the RMH DILD score, correlates with clinical presentation. Most events are low grade, and improve with treatment interruption, which should be considered early.
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Affiliation(s)
- Angelika Terbuch
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Crescens Tiu
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Irene Moreno Candilejo
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Division of Medical Oncology, START Madrid-HM Sanchinarro CIOCC Early Phase Program, Medical University Hospital of Sanchinarro, Madrid, Spain
| | - Mariana Scaranti
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Andra Curcean
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Dan Bar
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Miriam Estevez Timon
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Malaka Ameratunga
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Monash University, Melbourne, Australia
| | - Joo Ern Ang
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jonathan Ratoff
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Epsom and St. Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Anna R Minchom
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Udai Banerji
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Johann S de Bono
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Nina Tunariu
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Juanita S Lopez
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom.
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22
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Wang Y, Miao L, Hu Y, Zhou Y. The Efficacy and Safety of First-Line Chemotherapy in Patients With Non-small Cell Lung Cancer and Interstitial Lung Disease: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:1636. [PMID: 33014824 PMCID: PMC7506119 DOI: 10.3389/fonc.2020.01636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Lung cancer is a well-known comorbidity of interstitial lung disease (ILD), and the actual efficacy and safety of chemotherapy for patients with non-small cell lung cancer and interstitial lung disease (NSCLC-ILD) have not been determined. We conducted this meta-analysis to assess the efficacy and safety of chemotherapy for patients with NSCLC-ILD. Methods: We searched related studies from the Cochrane Library, PubMed, and Embase. The endpoints were objective response rate (ORR), disease control rate (DCR), 1-year overall survival rate (1-yOS rate), and first-line chemotherapy-related acute exacerbation of interstitial lung disease rate (AE-ILD rate). Results: We included 21 studies involving 684 patients in our analysis. The pooled ORR was 43% (95% CI: 38.0–49.0%), and the pooled DCR was 80.0% (95% CI: 75.7–83.9%). The modified overall 1-yOS rate was 33.0% (95% CI: 29.0–37.0%). The pooled AE-ILD rate was 8.07% (95% CI: 6.12–10.26%). Subgroup analysis revealed a trend for lower AE-ILD rate (4.98%; 95% CI: 2.44–8.37%) in patients with carboplatin plus nab-paclitaxel. Lung function and AE-ILD may be associated with the prognosis of patients with NSCLC-ILD. Conclusions: First-line chemotherapy is effective in patients with NSCLC-ILD, and the AE-ILD rate is acceptable, but the prognosis is limited. Future randomized controlled trials are needed to explore more appropriate treatment regimens to improve the prognosis of patients with NSCLC-ILD.
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Affiliation(s)
- Yanning Wang
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Liyun Miao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, China
| | - Yuxuan Hu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yujie Zhou
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, China
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23
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Fujita T, Kuroki T, Hayama N, Shiraishi Y, Amano H, Nakamura M, Hirano S, Tabeta H, Nakamura S. Pembrolizumab for Previously Untreated Patients with Advanced Non-small-cell Lung Cancer and Preexisting Interstitial Lung Disease. Intern Med 2020; 59:1939-1945. [PMID: 32389949 PMCID: PMC7492129 DOI: 10.2169/internalmedicine.4552-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Pembrolizumab has benefited patients with advanced non-small-cell lung cancer (NSCLC) with a programmed death-ligand (PD-L) 1 high expression, but little information is available regarding its safety for patients with interstitial lung disease (ILD). The aim of this study was to assess the efficacy and tolerability of pembrolizumab for patients with advanced NSCLC and preexisting ILD. Methods We retrospectively reviewed the medical records of five patients with advanced NSCLC and preexisting ILD who received pembrolizumab monotherapy in a first-line setting. Patients All patients had mild ILD and pulmonary emphysema with a forced vital capacity within the normal range. Pembrolizumab was administered at a dose of 200 mg/body on day 1 every 3 weeks. Results The overall response rate was 60%. Four patients developed pembrolizumab-induced lung injury, which was improved in all cases by corticosteroid therapy. One patient received pembrolizumab for two years, did not experience lung injury and achieved a complete response. Conclusion Pembrolizumab has a high risk of inducing lung injury in patients with preexisting ILD, although it may be very effective in NSCLC patients with a high PD-L1 expression, even concurrent with preexisting ILD. Further large-scale studies are needed to determine risk factors of pembrolizumab-induced lung injury in such patients.
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Affiliation(s)
- Tetsuo Fujita
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Tsuguko Kuroki
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Nami Hayama
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Yuka Shiraishi
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Hiroyuki Amano
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Makoto Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Satoshi Hirano
- Department of Medical Oncology, Funabashi Municipal Medical Center, Japan
| | - Hiroshi Tabeta
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Sukeyuki Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Japan
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24
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Minegishi Y, Gemma A, Homma S, Kishi K, Azuma A, Ogura T, Hamada N, Taniguchi H, Hattori N, Nishioka Y, Tanizawa K, Johkoh T, Yokoyama T, Mori K, Taguchi Y, Ebina M, Inase N, Hagiwara K, Ohnishi H, Mukae H, Inoue Y, Kuwano K, Chiba H, Ohta K, Tanino Y, Sakai F, Sugiyama Y. Acute exacerbation of idiopathic interstitial pneumonias related to chemotherapy for lung cancer: nationwide surveillance in Japan. ERJ Open Res 2020; 6:00184-2019. [PMID: 32494570 PMCID: PMC7248335 DOI: 10.1183/23120541.00184-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Chemotherapy-induced acute exacerbation (AEx) of idiopathic interstitial pneumonias (IIPs) seriously compromises the success of treatment of Japanese lung cancer patients. Here, we conducted a nationwide surveillance to clarify the risk of AEx and compare it with the survival benefit of chemotherapy for this population. Methods Advanced nonsmall cell lung cancer (NSCLC) or small cell lung cancer (SCLC) patients with IIPs were retrospectively analysed. For the surveillance of first-line chemotherapy in 2009, we gathered clinical data from 396 patients who received chemotherapy at 19 institutions between January 1990 and July 2009. In a consecutive retrospective study in 2012, we analysed data from 278 patients from 17 institutions who received second-line chemotherapy between April 2002 and March 2012. Results Of the 396 patients analysed, 13.1% developed chemotherapy-related AEx. Combination chemotherapies of carboplatin plus paclitaxel (CP) or carboplatin plus etoposide (CE) were frequently used as first-line treatments. The lowest incidence of AEx was 3.7% in CE, followed by 8.6% in CP. In the retrospective study, 16.2% of the 278 patients developed a second-line chemotherapy-related AEx. The overall response rate by second-line chemotherapy was 7.4% in NSCLC and 25.7% in SCLC. The median overall survival from second-line and first-line chemotherapy was 8.0 and 14.3 months in NSCLC, and 8.7 and 16.0 months in SCLC, respectively. Conclusion Combination chemotherapies consisting of CP or CE are candidates for standard first-line treatments for patients with advanced lung cancer accompanied by IIP. Second-line chemotherapy should be considered for patients remaining fit enough to receive it. The Japanese are at high risk of acute exacerbation of IPF. Therefore, chemotherapy for Japanese lung cancer patients with IIPs is challenging. However, appropriate chemotherapy may give a survival benefit, despite the risk of acute deterioration of IIPs.http://bit.ly/3cROaCy
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Affiliation(s)
- Yuji Minegishi
- Dept of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Dept of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Sakae Homma
- Dept of Respiratory Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kazuma Kishi
- Dept of Respiratory Medicine, Respiratory Center Toranomon Hospital, Tokyo, Japan
| | - Arata Azuma
- Dept of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Ogura
- Dept of Respiratory medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Naoki Hamada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Taniguchi
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Noboru Hattori
- Dept of Molecular and Internal Medicine Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuhiko Nishioka
- Dept of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kiminobu Tanizawa
- Dept of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Johkoh
- Dept of Radiology, Kinki Central Hospital of Mutual Aid Association of Public Teachers, Hyogo, Japan
| | - Takuma Yokoyama
- Dept of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazutaka Mori
- Second Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshio Taguchi
- Dept of Respiratory Medicine, Tenri Hospital, Tenri, Japan
| | - Masahito Ebina
- Tohoku Medical and Pharmaceutical University School of Medicine, Dept of Respiratory Medicine, Sendai, Japan
| | | | - Koichi Hagiwara
- Division of Pulmonary Medicine, Jichi Medical University, Shimono, Japan
| | - Hiroshi Ohnishi
- Dept of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroshi Mukae
- Dept of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Dept of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Chiba
- Dept of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ken Ohta
- Japan Anti-Tuberculosis Association Fukujuji Hospital, Tokyo, Japan
| | - Yoshinori Tanino
- Dept of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Fumikazu Sakai
- Dept of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
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[A Review of Drug Therapy of Lung Cancer with Interstitial Lung Disease]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:286-293. [PMID: 32316717 PMCID: PMC7210086 DOI: 10.3779/j.issn.1009-3419.2020.102.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interstitial lung disease (ILD) is a risk factor for lung cancer. Patients with lung cancer associated with ILD (LC-ILD) often appear clinically. During the treatment of LC-ILD, there is a risk of causing acute exacerbation or even death in the treatment of lung cancer. At the same time, combining ILD has become the exclusion criteria for prospective clinical trials of most lung cancers. Therefore, when lung cancer is combined with ILD, it often becomes a difficult point for the treatment of lung cancer. Because LC-ILD patients have a certain proportion in the clinic, it is necessary to explore the best treatment options. Here we review the results of existing clinical studies for reference.
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26
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Ohsawa M, Tsutani Y, Fujiwara M, Mimae T, Miyata Y, Okada M. Predicting Severe Postoperative Complication in Patients With Lung Cancer and Interstitial Pneumonia. Ann Thorac Surg 2020; 109:1054-1060. [DOI: 10.1016/j.athoracsur.2019.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/03/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
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27
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Fujita T, Kuroki T, Hayama N, Shiraishi Y, Amano H, Nakamura M, Hirano S, Tabeta H, Nakamura S. Pemetrexed Plus Platinum for Patients With Advanced Non-small Cell Lung Cancer and Interstitial Lung Disease. In Vivo 2020; 33:2059-2064. [PMID: 31662538 DOI: 10.21873/invivo.11704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM Pemetrexed plus platinum followed by pemetrexed maintenance has been one of the standard first-line treatments in advanced nonsquamous non-small cell lung cancer (NSCLC), but little is known regarding its safety and efficacy for patients with interstitial lung disease (ILD). PATIENTS AND METHODS The medical records of 24 patients with advanced nonsquamous NSCLC and preexisting ILD who received pemetrexed and platinum doublet therapy with and without pemetrexed maintenance in the first-line setting between December 2009 and June 2016, were retrospectively reviewed. RESULTS The median progression-free survival time was 4.7 months, and the median overall survival time was 9.5 months. Of the 24 patients analyzed, six received pemetrexed maintenance. Acute exacerbation of ILD (AE-ILD) occurred in five (20.8 %) of 24 patients, including two fatal cases. CONCLUSION The treatment with pemetrexed plus platinum has a high risk of AE-ILD in patients with advanced nonsquamous NSCLC and preexisting ILD.
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Affiliation(s)
- Tetsuo Fujita
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Tsuguko Kuroki
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Nami Hayama
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Yuka Shiraishi
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Hiroyuki Amano
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Makoto Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Satoshi Hirano
- Department of Medical Oncology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Hiroshi Tabeta
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
| | - Sukeyuki Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Kanasugi, Japan
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Abstract
Systemic therapy for advanced non-small cell lung cancer (NSCLC) has dramatically changed in the latest 15 years. Molecular-targeted therapy has brought about an era of precision medicine, and immune checkpoint inhibitors have brought hope for a cure for advanced NSCLC. In the wake of this remarkable advancement, lung cancer with comorbid interstitial pneumonia (IP) has been completely left behind, as most clinical trials exclude patients with comorbid IP. IP, especially idiopathic pulmonary fibrosis (IPF), is often accompanied by lung cancer, and acute exacerbation can develop during various cancer therapies, including surgery, radiotherapy and pharmacotherapy. In this review, we focus on the clinical questions concerning pharmacotherapy in cases of advanced lung cancer with comorbid IP and discuss what we can do with the currently available data.
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Affiliation(s)
- Eiki Ichihara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Nobuaki Miyahara
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
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The utility of ground-glass attenuation score for anticancer treatment-related acute exacerbation of interstitial lung disease among lung cancer patients with interstitial lung disease. Int J Clin Oncol 2019; 25:282-291. [PMID: 31720993 DOI: 10.1007/s10147-019-01576-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute exacerbation (AE) of interstitial lung disease (ILD) is a fatal adverse event in the treatment of lung cancer patients with ILD. The value of pre-treatment radiological findings obtained by high-resolution computed tomography for the detection of anticancer treatment-related AE of ILD has not been established. METHODS Two medical record-based retrospective studies were performed. The chemotherapy cohort included 105 lung cancer patients with ILD who received chemotherapy at Tokyo Medical and Dental University between October 2008 and December 2017. The immune checkpoint inhibitor (ICI) cohort included 48 advanced non-small cell lung cancer patients with ILD treated with ICIs at nine institutions between January 2016 and September 2018. Variables were compared between AE-positive and -negative groups. Candidate variables were analyzed by multivariate logistic regression. A P value < 0.05 was considered statistically significant. RESULTS Anticancer treatment-related AE of ILD occurred in 12 patients (11.4%) in the chemotherapy cohort and seven patients (14.5%) in the ICI cohort. In the multivariate logistic regression analysis, ground-glass attenuation (GGA) score was the only factor significantly associated with the development of AE of ILD in both cohorts (P = 0.037 and 0.01 in the chemotherapy and ICI cohorts, respectively). CONCLUSION Evaluation of GGA may help predict anticancer treatment-related AE of ILD.
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Kenmotsu H, Yoh K, Mori K, Ono A, Baba T, Fujiwara Y, Yamaguchi O, Ko R, Okamoto H, Yamamoto N, Ninomiya T, Ogura T, Kato T. Phase II study of nab-paclitaxel + carboplatin for patients with non-small-cell lung cancer and interstitial lung disease. Cancer Sci 2019; 110:3738-3745. [PMID: 31608537 PMCID: PMC6890441 DOI: 10.1111/cas.14217] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
The prognosis of non‐small‐cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) is poor, and 5%‐20% of those receiving chemotherapy experience ILD exacerbation. To evaluate the safety and efficacy of nab‐paclitaxel plus carboplatin for NSCLC patients with ILD, we undertook a multicenter phase II study. Chemotherapy‐naïve patients with advanced NSCLC and mild or moderate ILD received nab‐paclitaxel (100 mg/m2, days 1, 8, and 15) plus carboplatin (area under the curve = 6, day 1) every 3 weeks for 4 cycles (maximum, 6 cycles). Interstitial lung diseases were diagnosed based on criteria for fibrosing interstitial pneumonia. The primary endpoint was the prevalence of exacerbation‐free ILD 28 days after completion of protocol treatment. Secondary endpoints were response rate, progression‐free survival, overall survival, prevalence of exacerbation‐free ILD, and toxicity. Ninety‐four patients were enrolled, and 92 patients received any protocol treatment. Median age was 70 years, and 58% had nonsquamous histology. In the primary analysis, the prevalence of exacerbation‐free ILD 28 days after protocol treatment was 95.7% (88/92; 90% confidence interval, 90.3‐98.5), which met the primary endpoint. Response rate was 51% (95% confidence interval, 40%‐62%). At the time of data cut‐off, median progression‐free survival was 6.2 months, and median overall survival was 15.4 months. The most common grade 3/4 adverse events were neutropenia (75%), leukopenia (53%), anemia (48%), and thrombocytopenia (20%). Two treatment‐related deaths (1 each of pulmonary infection and ILD exacerbation) were observed. This study showed that a combination of nab‐paclitaxel with carboplatin was tolerable in NSCLC patients with mild or moderate ILD in terms of safety. This study is registered at the University Hospital Medical Information Network (UMIN) Clinical Trial Registry (UMIN 000012989).
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Affiliation(s)
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keita Mori
- Clinical Trial Coordination Office, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ou Yamaguchi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryo Ko
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Ninomiya
- Department of Respiratory Medicine and Allergy, Okayama University Hospital, Okayama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Terufumi Kato
- Division of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
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31
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Ogura T, Takigawa N, Tomii K, Kishi K, Inoue Y, Ichihara E, Homma S, Takahashi K, Akamatsu H, Ikeda S, Inase N, Iwasawa T, Ohe Y, Ohta H, Onishi H, Okamoto I, Ogawa K, Kasahara K, Karata H, Kishimoto T, Kitamura Y, Gemma A, Kenmotsu H, Sakashita H, Sakamoto S, Sekine K, Takiguchi Y, Tada Y, Toyooka S, Nakayama Y, Nishioka Y, Hagiwara K, Hanibuchi M, Fukuoka J, Minegishi Y, Yanagihara T, Yamamoto N, Yamamoto H, Gaga M, Fong KM, Powell CA, Kiura K. Summary of the Japanese Respiratory Society statement for the treatment of lung cancer with comorbid interstitial pneumonia. Respir Investig 2019; 57:512-533. [PMID: 31377122 DOI: 10.1016/j.resinv.2019.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022]
Abstract
Dramatic progress in targeted therapy and immunotherapy has been changing clinical practices in lung cancer. With the accumulation of clinical practice, it has become clear that pre-existing interstitial pneumonia (IP) could be a risk factor for drug-induced lung injury, which has enhanced awareness regarding the difficulty in treating lung cancer with comorbid IP. Unfortunately, there is only low-grade evidence in the field of lung cancer with comorbid IP, because almost all clinical trials exclude such patients. There have been very few specialized clinical trials for patients with lung cancer and underlying IPs thus far. Therefore, it is necessary to treat such cases empirically or to give up on the treatment itself. Considering these circumstances, establishing how to treat lung cancer with comorbid IP is an urgent issue. This paper is a summary of the official statement reported by the Diffuse Lung Disease/Thoracic Oncology Assembly and the Japanese Respiratory Society (JRS) in 2017, which attempts to approach lung cancer with comorbid IP systematically.
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Affiliation(s)
- Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Nagio Takigawa
- Department of General Internal Medicine 4, Kawasaki Medical School, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Eiki Ichihara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Hiroaki Akamatsu
- Third Department of Internal Medicine, Wakayama Medical University, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Japan
| | - Hiromitsu Ohta
- Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Japan
| | | | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kazumasa Ogawa
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Japan
| | - Hiroki Karata
- Department of Pathology, Nagasaki University Hospital, Japan
| | - Takumi Kishimoto
- Department of Research, Research and Training Center for Asbestos-Related Diseases, Japan
| | - Yuka Kitamura
- Department of Pathology, Nagasaki University Hospital, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | | | - Hiroyuki Sakashita
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University Omori Medical Center, Japan
| | | | - Yuichi Takiguchi
- Department of Medical Oncology, Chiba University Hospital, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Science, Tokushima University, Japan
| | - Koichi Hagiwara
- Department of Pulmonary Medicine, Department of Internal Medicine Jichi Medical University, Japan
| | - Masaki Hanibuchi
- Department of Internal Medicine, Shikoku Central Hospital, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, Japan
| | - Yuji Minegishi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Toyoshi Yanagihara
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University, Japan
| | - Hiromasa Yamamoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Mina Gaga
- Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital "Sotiria", Greece
| | - Kwun M Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, School of Medicine, The University of Queensland, Australia
| | - Charles A Powell
- Department of Medicine, Icahn School of Medicine at Mount Sinai, USA
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan.
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Real-World Evidence of Safety and Efficacy of Carboplatin plus Nanoparticle Albumin-Bound Paclitaxel in Patients with Advanced Non-Small-Cell Lung Cancer and Preexisting Interstitial Lung Disease: A Retrospective Study. Can Respir J 2019; 2019:5315903. [PMID: 31015884 PMCID: PMC6446117 DOI: 10.1155/2019/5315903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/29/2019] [Accepted: 02/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background Standard chemotherapy for advanced non-small-cell lung cancer (NSCLC) with preexisting interstitial lung disease (ILD) has not yet been established. Although a combination of carboplatin and paclitaxel is most frequently used for patients with advanced NSCLC and ILD, the safety and efficacy of carboplatin plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel) are yet to be elucidated. Objectives This study aimed to evaluate the safety and efficacy of carboplatin plus nab-paclitaxel for advanced NSCLC with ILD. Methods This retrospective study included nine patients with advanced NSCLC and ILD who received carboplatin plus nab-paclitaxel as first-line chemotherapy at the National Hospital Organization Kanazawa Medical Center between April 2013 and December 2017. The ILD-GAP index was used to evaluate mortality risk of baseline ILD. Results A usual interstitial pneumonia (UIP) pattern of ILD was observed in five (55.6%) patients on their baseline high-resolution computed tomography (HRCT) scans. The median ILD-GAP index was 4 (range, 1–5), and six (66.7%) patients had ILD-GAP index ≥4. We observed no ILD exacerbations or chemotherapy-related deaths. The overall response and disease control rates were 77.8% (95% CI, 40.0–97.2) and 88.9% (95% CI, 51.8–97.2), respectively. The median progression-free survival and overall survival were 5.8 months (95% CI, 2.1–7.7) and 8.0 months (95% CI, 2.6–16.8), respectively. Conclusions Carboplatin plus nab-paclitaxel showed favorable safety and efficacy in patients who had advanced NSCLC and ILD with a high risk of mortality. Prospective studies are required to further confirm these results.
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Saijo A, Hanibuchi M, Ogino H, Otsuka K, Goto H, Nokihara H, Nishioka Y. Paclitaxel for relapsed small-cell lung cancer patients with idiopathic interstitial pneumonias. Mol Clin Oncol 2019; 10:541-546. [PMID: 30967948 DOI: 10.3892/mco.2019.1828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 01/06/2023] Open
Abstract
Although first-line chemotherapy is highly sensitive against small-cell lung cancer (SCLC), most patients subsequently experience disease progression. Topotecan is the standard therapy for sensitive-relapsed SCLC patients, and subgroup analysis of a randomized phase III trial suggests that amrubicin is effective for refractory-relapsed SCLC. However, because of the lack of the evidence based on clinical trials, the effectiveness of systemic chemotherapy for relapsed SCLC patients with idiopathic interstitial pneumonias (IIPs) is unclear. In the presentstudy, 17 relapsed SCLC patients with IIPs who received a paclitaxel (PTX)-containing regimen as a second-line chemotherapy were retrospectively reviewed. The overall response rate and the disease control rate of the PTX-containing regimens were 29.4 and 47.1%, respectively. The median progression-free survival and the overall survival of the regimens were 2.7 months [95% confidence interval (CI), 1.6-3.6 months] and 3.6 months (95% CI, 2.3-14.0 months), respectively. Grade 3-4 neutropenia and febrile neutropenia occurred in 12 (70.6%) and 2 (11.8%) patients, respectively. During the treatment period, acute exacerbation (AE) of IIPs was observed in five patients (29.4%). Treatment-associated fatality was observed in 1 patient with febrile neutropenia and in 1 patient with AE of IIPs. PTX had promising anti-tumor activity against refractory-relapsed SCLC with IIPs. However, the survival benefit of the treatment was limited because of the high incidence of AE of IIPs and treatment-related death.
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Affiliation(s)
- Atsuro Saijo
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Masaki Hanibuchi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Kenji Otsuka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima 770-8503, Japan
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Igawa S, Nishinarita N, Takakura A, Ozawa T, Harada S, Kusuhara S, Niwa H, Hosotani S, Sone H, Nakahara Y, Fukui T, Mitsufuji H, Yokoba M, Kubota M, Katagiri M, Sasaki J, Naoki K. Real-world evaluation of carboplatin plus a weekly dose of nab-paclitaxel for patients with advanced non-small-cell lung cancer with interstitial lung disease. Cancer Manag Res 2018; 10:7013-7019. [PMID: 30588105 PMCID: PMC6298387 DOI: 10.2147/cmar.s189556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The optimal chemotherapy regimen for non-small-cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) remains unknown. Therefore, in this study, we investigated the real-world efficacy and safety of carboplatin (CBDCA) plus nab-paclitaxel (nab-PTX) as a first-line regimen for NSCLC patients with ILD. Patients and methods We retrospectively reviewed advanced NSCLC patients with ILD who had received CBDCA plus nab-PTX as a first-line chemotherapy regimen between April 2013 and March 2018. Patients were diagnosed with ILD based on the findings of a pretreatment high-resolution computed tomography of the chest. Results The 34 patients enrolled in this study were included in the efficacy and safety analysis. Collagen vascular disease or a history of exposure to dust or asbestos was not reported for any patients. The median age of patients was 71 years (range, 59–83 years), and 32 patients had a performance status of 0 or 1. The overall response rate was 38.2%. The median progression-free survival and overall survival were 5.8 months and 12.7 months, respectively. Chemotherapy-related acute exacerbation of ILD was observed in two patients (5.7%). Other toxicities were feasible, and no treatment-related deaths occurred. Conclusion CBDCA plus nab-PTX, as a first-line chemotherapy regimen for NSCLC, showed favorable efficacy and safety in patients with preexisting ILD.
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Affiliation(s)
- Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Noriko Nishinarita
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Akira Takakura
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Takahiro Ozawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Shinya Harada
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Seiichiro Kusuhara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Hideyuki Niwa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya 460-0001, Aichi, Japan
| | - Shinji Hosotani
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Hideyuki Sone
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan, .,Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Kanagawa, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Hisashi Mitsufuji
- Kitasato University School of Nursing, Sagamihara 252-0329, Kanagawa, Japan
| | - Masanori Yokoba
- School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Kanagawa, Japan
| | - Masaru Kubota
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
| | - Masato Katagiri
- School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara 252-0374, Kanagawa, Japan,
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Kashiwada T, Saito Y, Terasaki Y, Hisakane K, Takeuchi S, Sugano T, Miyanaga A, Noro R, Minegishi Y, Seike M, Kubota K, Gemma A. Interstitial lung disease associated with nanoparticle albumin-bound paclitaxel treatment in patients with lung cancer. Jpn J Clin Oncol 2018; 49:165-173. [DOI: 10.1093/jjco/hyy180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 11/08/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Takeru Kashiwada
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kakeru Hisakane
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Susumu Takeuchi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Teppei Sugano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuji Minegishi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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36
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Miyamoto A, Kurosaki A, Moriguchi S, Takahashi Y, Ogawa K, Murase K, Hanada S, Uruga H, Takaya H, Morokawa N, Fujii T, Hoshino J, Kishi K. Reduced area of the normal lung on high-resolution computed tomography predicts poor survival in patients with lung cancer and combined pulmonary fibrosis and emphysema. Respir Investig 2018; 57:140-149. [PMID: 30472091 DOI: 10.1016/j.resinv.2018.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/22/2018] [Accepted: 10/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to determine the radiologic predictors and clarify the clinical features related to survival in patients with combined pulmonary fibrosis and emphysema (CPFE) and lung cancer. METHODS We retrospectively reviewed the medical chart data and high-resolution computed tomography (HRCT) findings for 81 consecutive patients with CPFE and 92 primary lung cancers (70 men, 11 women; mean age, 70.9 years). We selected 8 axial HRCT images per patient, and visually determined the normal lung, modified Goddard, and fibrosis scores. Multivariate analysis was performed using the Cox proportional hazards regression model. RESULTS The major clinical features were a high smoking index of 54.8 pack-years and idiopathic pulmonary fibrosis (n = 44). The major lung cancer profile was a peripherally located squamous cell carcinoma (n = 40) or adenocarcinoma (n = 31) adjacent to emphysema in the upper/middle lobe (n = 27) or fibrosis in the lower lobe (n = 26). The median total normal lung, modified Goddard, and fibrosis scores were 10, 8, and 8, respectively. TNM Classification of malignant tumors (TNM) stage I, II, III, and IV was noted in 37, 7, 26, and 22 patients, respectively. Acute exacerbation occurred in 20 patients. Multivariate analysis showed that a higher normal lung score and TNM stage were independent radiologic and clinical predictors of poor survival at the time of diagnosis of lung cancer. CONCLUSIONS A markedly reduced area of normal lung on HRCT was a relevant radiologic predictor of survival.
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Affiliation(s)
- Atsushi Miyamoto
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-tuberculosis Association, 3-1-24 Matsuyama Kiyose-shi, Tokyo 204-8522, Japan.
| | - Shuhei Moriguchi
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Yui Takahashi
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Kazumasa Ogawa
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Kyoko Murase
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Hironori Uruga
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Hisashi Takaya
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Nasa Morokawa
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan; Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Junichi Hoshino
- Clinical Research Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan; Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan.
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37
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Homma S, Bando M, Azuma A, Sakamoto S, Sugino K, Ishii Y, Izumi S, Inase N, Inoue Y, Ebina M, Ogura T, Kishi K, Kishaba T, Kido T, Gemma A, Goto Y, Sasaki S, Johkoh T, Suda T, Takahashi K, Takahashi H, Taguchi Y, Date H, Taniguchi H, Nakayama T, Nishioka Y, Hasegawa Y, Hattori N, Fukuoka J, Miyamoto A, Mukae H, Yokoyama A, Yoshino I, Watanabe K. Japanese guideline for the treatment of idiopathic pulmonary fibrosis. Respir Investig 2018; 56:268-291. [PMID: 29980444 DOI: 10.1016/j.resinv.2018.03.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/05/2018] [Accepted: 03/30/2018] [Indexed: 06/08/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology which accounts for a large proportion of cases of idiopathic interstitial pneumonia. It has a very poor prognosis with a 5-year survival rate of 30% or below, and so far there has been no guideline in Japan offering an established effective therapy based on evidence. In addition to the establishment of basic therapies, there is also an urgent need to establish therapies to deal with complications, as death occurs in many cases due to acute exacerbation or comorbid lung cancer. It was therefore decided to formulate a guideline in order to promote evidence-based clinical practice, to further improve the quality of medical treatment in the clinical setting, and to allow the benefits to be enjoyed by the public.
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Affiliation(s)
- Sakae Homma
- Toho University, Faculty of Medicine, Omori Medical Center, Department of Respiratory Medicine, 6-11-1 Omori Nishi, Ota-ku, Tokyo 143-8541, Japan.
| | - Masashi Bando
- Jichi Medical University, Department of Medicine, Division of Pulmonary Medicine, Japan
| | - Arata Azuma
- Nippon Medical School Graduate School of Medicine, Department of Pulmonary Medicine and Oncology, Japan
| | - Susumu Sakamoto
- Toho University, Faculty of Medicine, Omori Medical Center, Department of Respiratory Medicine, 6-11-1 Omori Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Keishi Sugino
- Toho University, Faculty of Medicine, Omori Medical Center, Department of Respiratory Medicine, 6-11-1 Omori Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshiki Ishii
- Dokkyo Medical University, School of Medicine, Department of Pulmonary Medicine and Clinical Immunology, Japan
| | - Shinyu Izumi
- National Center for Global Health and Medicine, Department of Respiratory Medicine, Japan
| | | | - Yoshikazu Inoue
- National Hospital Organization Kinki, Chuo Chest Medical Center, Clinical Research Center, Japan
| | - Masahito Ebina
- Tohoku Medical and Pharmaceutical University School of Medicine, Department of Respiratory Medicine, Japan
| | - Takashi Ogura
- Kanagawa Cardiovascular and Respiratory Center, Department of Respiratory Medicine, Japan
| | - Kazuma Kishi
- Toranomon Hospital, Department of Respiratory Medicine, Respiratory Center, Japan
| | - Tomoo Kishaba
- Okinawa Chubu Hospital, Department of Respiratory Medicine, Japan
| | - Takashi Kido
- University of Occupational and Environmental Health, Japan, Department of Respiratory Medicine, Japan
| | - Akihiko Gemma
- Nippon Medical School Graduate School of Medicine, Department of Pulmonary Medicine and Oncology, Japan
| | - Yoshihito Goto
- Kyoto University, Graduate School of Medicine and Public Health, Department of Health Informatics, Japan
| | - Shinichi Sasaki
- Juntendo University Urayasu Hospital, Department of Respiratory Medicine, Japan
| | - Takeshi Johkoh
- Kinki Central Hospital of Mutual Aid, Association of Public Schoolteachers, Department of Radiology, Japan
| | - Takafumi Suda
- Hamamatsu University School of Medicine,Second Division, Department of Internal Medicine, Japan
| | - Kazuhisa Takahashi
- Juntendo University, Graduate School of Medicine, Department of Respiratory Medicine, Japan
| | - Hiroki Takahashi
- Sapporo Medical University, School of Medicine, Department of Respiratory Medicine and Allergology, Japan
| | - Yoshio Taguchi
- Tenri Hospital, Department of Respiratory Medicine, Japan
| | - Hiroshi Date
- Kyoto University, Graduate School of Medicine, Department of Thoracic Surgery, Japan
| | - Hiroyuki Taniguchi
- Tosei General Hospital, Department of Respiratory and Allergic Diseases, Japan
| | - Takeo Nakayama
- Kyoto University, Graduate School of Medicine and Public Health, Department of Health Informatics, Japan
| | - Yasuhiko Nishioka
- Tokushima University Graduate School of Medical Sciences, Department of Respiratory Medicine and Rheumatology, Japan
| | - Yoshinori Hasegawa
- Nagoya University Graduate School of Medicine, Department of Respiratory Medicine, Japan
| | - Noboru Hattori
- Hiroshima University, Graduate School of Biomedical and Health Sciences, Department of Molecular and Internal Medicine, Japan
| | - Junya Fukuoka
- Nagasaki University, Graduate School of Biomedical Sciences, Department of Pathology, Japan
| | - Atsushi Miyamoto
- Toranomon Hospital, Department of Respiratory Medicine, Respiratory Center, Japan
| | - Hiroshi Mukae
- Nagasaki University Graduate School of Biomedical Sciences, Department of Respiratory Medicine, Japan
| | - Akihito Yokoyama
- Kochi University, Kochi Medical School, Department of Hematology and Respiratory Medicine, Japan
| | - Ichiro Yoshino
- Chiba University, Graduate School of Medicine, Department of General Thoracic Surgery, Japan
| | - Kentaro Watanabe
- General Medical Research Center, Fukuoka University School of Medicine, Japan
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Fujita T, Hiroishi T, Shikano K, Yanagisawa A, Hayama N, Amano H, Nakamura M, Hirano S, Tabeta H, Nakamura S. The Safety and Efficacy of Treatment with Nab-paclitaxel and Carboplatin for Patients with Advanced Squamous Non-small Cell Lung Cancer Concurrent with Idiopathic Interstitial Pneumonias. Intern Med 2018; 57:1827-1832. [PMID: 29434143 PMCID: PMC6064686 DOI: 10.2169/internalmedicine.0404-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Although lung squamous cell carcinoma (SCC) accounts for 20-30% of lung cancer cases, new treatment options are limited. The CA031 study showed that nanoparticle albumin-bound-paclitaxel (nab-PTX) plus carboplatin produced a significantly higher overall response rate (41%) than solvent-based paclitaxel plus carboplatin in patients with lung SCC. However, the safety and efficacy of combination chemotherapy of nab-PTX and carboplatin has not yet been established for patients with concurrent lung SCC and idiopathic interstitial pneumonias (IIPs). The aim of this study was to assess the safety and efficacy profiles of nab-PTX and carboplatin in patients with lung SCC and concurrent IIPs. Methods Eight patients with inoperable-stage lung SCC and IIPs were treated with nab-PTX plus carboplatin in a first-line setting between June 2013 and December 2016. One of the eight was a woman, and the median age was 77 (range=72-80) years. Their clinical outcomes, including chemotherapy-associated acute exacerbation of IIPs, were retrospectively investigated. Results The overall response rate was 50%, the median progression-free survival time was 5.6 months, and the median overall survival time was 8.1 months. No patients experienced chemotherapy-related exacerbation of IIPs in the first-line treatment with nab-PTX plus carboplatin. However, IIPs worsened in two of four patients who received second-line chemotherapy. Conclusion Combination chemotherapy of nab-PTX and carboplatin may be an effective and safe treatment option for patients with inoperable lung SCC with IIPs. To confirm this, a large-scale prospective study is needed.
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Affiliation(s)
- Tetsuo Fujita
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Takuma Hiroishi
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Kohei Shikano
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Asako Yanagisawa
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Noriko Hayama
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Hiroyuki Amano
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Makoto Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Satoshi Hirano
- Department of Medical Oncology, Funabashi Municipal Medical Center, Japan
| | - Hiroshi Tabeta
- Department of Respirology, Funabashi Municipal Medical Center, Japan
| | - Sukeyuki Nakamura
- Department of Respirology, Funabashi Municipal Medical Center, Japan
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39
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Kobayashi H, Naito T, Omae K, Omori S, Nakashima K, Wakuda K, Ono A, Kenmotsu H, Murakami H, Endo M, Harada H, Takahashi T. Impact of Interstitial Lung Disease Classification on the Development of Acute Exacerbation of Interstitial Lung Disease and Prognosis in Patients with Stage III Non-Small-Cell Lung Cancer and Interstitial Lung Disease Treated With Chemoradiotherapy. J Cancer 2018; 9:2054-2060. [PMID: 29896291 PMCID: PMC5995939 DOI: 10.7150/jca.24936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/10/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction: Data on the efficacy and risk of curative-intent chemoradiotherapy in patients with inoperable stage III non-small-cell lung cancer (NSCLC) and interstitial lung disease (ILD) are limited. The aim of this study was to explore the impact of ILD classification on acute exacerbation (AE) of ILD and prognosis in patients with stage III NSCLC and ILD treated with chemoradiotherapy. Materials and methods: We retrospectively reviewed the medical records of patients with stage III NSCLC and ILD treated with curative-intent chemoradiotherapy as the first-line treatment at the Shizuoka Cancer Center between June 2009 and May 2014. Results: Of 37 patients, 17 (46%) developed AE of ILD worse than grade 3 within 1 year after the last irradiation. In univariate analysis, the incidence rate of AE of ILD was lower in patients with a non-usual interstitial pneumonia (UIP) pattern than in those with a UIP pattern. Multivariate analysis showed that ILD classification was significantly associated with the incidence of AE of ILD. The median overall survival (OS) durations in patients with a non-UIP pattern and a UIP pattern were 16.5 and 9.3 months, respectively. In univariate analysis, patients with a non-UIP pattern showed better survival. Multivariate analysis showed that ILD classification was a significant independent prognostic factor. Conclusion: The incidence of AE of ILD was high in patients with stage III NSCLC and ILD treated with chemoradiotherapy as the first-line treatment. However, diagnosis of a non-UIP pattern could predict lower risk of AE of ILD and longer OS durations.
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Affiliation(s)
- Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiro Omae
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazuhisa Nakashima
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.,Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Radiation Therapy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Shizuoka Cancer Center, Shizuoka, Japan
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40
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Niwa H, Otani S, Nakada N, Sasaki J, Saka H, Masuda N. Nab-paclitaxel plus carboplatin as an effective and safe chemotherapy regimen for pulmonary carcinosarcoma with interstitial lung disease: A case report. Respir Med Case Rep 2018; 23:131-135. [PMID: 29719799 PMCID: PMC5925955 DOI: 10.1016/j.rmcr.2018.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 11/26/2022] Open
Abstract
Carcinosarcoma is a rare histological type of non-small cell carcinoma (NSCLC), and its prognosis has been reported to be worse compared with other NSCLCs. Nanoparticle albumin-bound paclitaxel (nab-PTX) + carboplatin (CBDCA) achieves a favorable response rate in patients with non-small cell lung cancer (NSCLC). We administered nab-PTX + CBDCA to a 68-year-old man with postoperative recurrent carcinosarcoma with interstitial lung disease (ILD). A partial response was evident after four cycles of chemotherapy. To the best of our knowledge, the present study is the first to report the safety and efficacy of nab-PTX + CBDCA for treating carcinosarcoma with ILD.
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Affiliation(s)
- Hideyuki Niwa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Aichi, Japan
- Corresponding author. Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru Naka-ku, Nagoya, Aichi, 460-0001, Japan.
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Norihiro Nakada
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Noriyuki Masuda
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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41
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Kobayashi H, Naito T, Omae K, Omori S, Nakashima K, Wakuda K, Ono A, Kenmotsu H, Murakami H, Endo M, Takahashi T. ILD-NSCLC-GAP index scoring and staging system for patients with non-small cell lung cancer and interstitial lung disease. Lung Cancer 2018; 121:48-53. [PMID: 29858026 DOI: 10.1016/j.lungcan.2018.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/27/2018] [Accepted: 04/24/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with advanced non-small cell lung cancer (NSCLC) and interstitial lung disease (ILD) are commonly excluded from most clinical trials because of acute exacerbation (AE) of ILD triggered by chemotherapy. Data on the efficacy and feasibility of chemotherapy are limited in this patient population. Recently, the ILD-GAP index and staging system was reported as a clinical prognostic factor associated with mortality in patients with ILD. Therefore, we evaluated the incidence of ILD-AE during the surveillance term in this study and the prognosis in patients with NSCLC and ILD using a modified ILD-GAP (ILD-NSCLC-GAP) index scoring system. MATERIALS AND METHODS The medical records of patients with NSCLC and ILD who underwent a pulmonary function test before initiation of platinum-based chemotherapy as first-line treatment at the Shizuoka Cancer Center between September 2002 and December 2014 were reviewed retrospectively. Among these patients, we compared the incidence of ILD-AE, one-year survival rate, and overall survival (OS) between the ILD-NSCLC-GAP index scores and stages. RESULTS Of the 78 patients included, 21 (27%; 95% confidence interval [CI], 18%-38%) had ILD-AE during the surveillance term in this study. The one-year survival and median OS rates were 49% and 11.3 months, respectively. The incidence of ILD-AE increased gradually and the one-year survival and median OS rates decreased gradually with increasing ILD-NSCLC-GAP index scores and stages. CONCLUSION The ILD-NSCLC-GAP index scoring and staging system may be a useful tool to calculate a prediction of the incidence of ILD-AE and its prognosis for patients with NSCLC and ILD.
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Affiliation(s)
- Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiro Omae
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
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Otsubo K, Okamoto I, Hamada N, Nakanishi Y. Anticancer drug treatment for advanced lung cancer with interstitial lung disease. Respir Investig 2018; 56:307-311. [PMID: 29764748 DOI: 10.1016/j.resinv.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 11/19/2022]
Abstract
Interstitial lung disease (ILD) is a risk factor for lung cancer development and is frequently observed in patients with lung cancer. Individuals with ILD have been excluded from most prospective clinical trials of lung cancer therapies because of the risk of ILD acute exacerbation. Thus, the optimal anticancer drug treatment for such patients has yet to be established. Tyrosine kinase inhibitors are avoided for the treatment of advanced non-small cell lung cancer (NSCLC) with ILD because of the concern of acute exacerbation, and information on the effects of immune-checkpoint inhibitors is limited in these patients. Only three prospective single-arm studies of cytotoxic chemotherapies for advanced lung cancer with ILD have been reported. Based on the results of these studies and those of retrospective analyses, carboplatin and either paclitaxel or nab-paclitaxel are often selected in daily clinical practice for patients with NSCLC and ILD, whereas platinum plus etoposide is selected for those with small cell lung cancer and ILD. Although the antitumor activity of first-line platinum-based chemotherapy appears similar in advanced lung cancer patients with and without ILD, its impact on overall survival of the former patients is limited. The risks and benefits of chemotherapy must therefore be carefully explained before treatment initiation, and careful follow-up is necessary for such patients, especially those with the usual interstitial pneumonia pattern, a risk factor for chemotherapy-related exacerbation. Prospective clinical studies with large patient populations are still required to establish the appropriate treatments for advanced lung cancer with ILD.
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Affiliation(s)
- Kohei Otsubo
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Cancer Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Naoki Hamada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Yasuda Y, Hattori Y, Tohnai R, Ito S, Kawa Y, Kono Y, Urata Y, Nogami M, Takenaka D, Negoro S, Satouchi M. The safety and efficacy of carboplatin plus nanoparticle albumin-bound paclitaxel in the treatment of non-small cell lung cancer patients with interstitial lung disease. Jpn J Clin Oncol 2018; 48:89-93. [PMID: 29036303 DOI: 10.1093/jjco/hyx142] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/12/2017] [Indexed: 11/13/2022] Open
Abstract
Background The optimal chemotherapy regimen for non-small cell lung cancer patients with interstitial lung disease is unclear. We therefore investigated the safety and efficacy of carboplatin plus nab-paclitaxel as a first-line regimen for non-small cell lung cancer in patients with interstitial lung disease. Methods We retrospectively reviewed advanced non-small cell lung cancer patients with interstitial lung disease who received carboplatin plus nab-paclitaxel as a first-line chemotherapy regimen at Hyogo Cancer Center between February 2013 and August 2016. interstitial lung disease was diagnosed according to the findings of pretreatment chest high-resolution computed tomography. Results Twelve patients were included (male, n = 11; female, n = 1). The overall response rate was 67% and the disease control rate was 100%. The median progression free survival was 5.1 months (95% CI: 2.9-8.3 months) and the median overall survival was 14.9 months (95% CI: 4.8-not reached). A chemotherapy-related acute exacerbation of interstitial lung disease was observed in one patient; the extent of this event was Grade 2. There were no treatment-related deaths. Conclusions Carboplatin plus nab-paclitaxel, as a first-line chemotherapy regimen for non-small cell lung cancer, showed favorable efficacy and safety in patients with preexisting interstitial lung disease.
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Affiliation(s)
- Yuichiro Yasuda
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | | | - Rie Tohnai
- Department of Thoracic Oncology, Hyogo Cancer Center
| | - Shoichi Ito
- Department of Thoracic Oncology, Hyogo Cancer Center
| | | | - Yuko Kono
- Department of Thoracic Oncology, Hyogo Cancer Center
| | - Yoshiko Urata
- Department of Thoracic Oncology, Hyogo Cancer Center
| | | | - Daisuke Takenaka
- Department of Diagnostic Radiology, Hyogo Cancer Center, Hyogo, Japan
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Masuda T, Hirano C, Horimasu Y, Nakashima T, Miyamoto S, Iwamoto H, Ohshimo S, Fujitaka K, Hamada H, Hattori N. The extent of ground-glass attenuation is a risk factor of chemotherapy-related exacerbation of interstitial lung disease in patients with non-small cell lung cancer. Cancer Chemother Pharmacol 2017; 81:131-139. [PMID: 29143072 DOI: 10.1007/s00280-017-3476-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Chemotherapy-related acute exacerbation (AE) of interstitial lung disease (ILD) is observed in certain patients with non-small cell lung cancer (NSCLC) who have ILD. Although the prognosis of AE-ILD is extremely poor, there are no established risk factors for its occurrence. Therefore, we retrospectively investigated whether high-resolution computed tomography (HRCT) findings could identify risk factors for AE-ILD. MATERIALS AND METHODS Between January 2005 and December 2016, 35 patients with NSCLC who received chemotherapy at Hiroshima University Hospital and were diagnosed with ILD on HRCT were enrolled. The extent of ground-glass attenuation (GGA), reticulation, honeycomb appearance, and emphysema, as well as the presence of micronodules, traction bronchiectasis, and consolidation were evaluated in five levels of the lung bilaterally. The HRCT scores of GGA, reticulation, honeycomb appearance, and emphysema were determined by the following formula: 100 × sum of the extent of the HRCT findings/lung area. RESULTS Thirty-five patients underwent various first- to fifth-line chemotherapy regimens. Nine patients (25.7%) developed AE-ILD. The median HRCT scores of GGA and reticulation were significantly higher in patients with AE-ILD than in those without. On univariate analysis, a GGA area score ≥ 24.8, reticulation area score ≥ 19.5, and KL-6 level ≥ 946 U/mL were significant risk factors. Multivariate logistic analysis revealed that only a GGA area score ≥ 24.8 was an independent risk factor of AE-ILD. CONCLUSIONS The GGA area on HRCT is a risk factor for chemotherapy-related AE-ILD. Therefore, this parameter can be used to predict the risk of AE-ILD before administering chemotherapy.
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Affiliation(s)
- Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Chihiro Hirano
- Hiroshima Atomic Bomb Casualty Council, 3-8-6 Sendamachi, Naka-ku, Hiroshima, 730-0052, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintarou Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Niwa H, Nakahara Y, Yokoba M, Mitsufuji H, Sasaki J, Masuda N. Safety and efficacy of carboplatin plus nab-paclitaxel for treating advanced non-small-cell lung cancer with interstitial lung disease. Mol Clin Oncol 2017; 7:604-608. [PMID: 28855994 DOI: 10.3892/mco.2017.1359] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/30/2017] [Indexed: 12/26/2022] Open
Abstract
There are few established treatments for patients with non-small-cell lung cancer (NSCLC) with interstitial lung disease (ILD). The safety and efficacy of albumin-bound paclitaxel (nab-paclitaxel) in combination with carboplatin is uncertain, although the combination of carboplatin and paclitaxel is the most common regimen for treating NSCLC patients with ILD. A total of 9 NSCLC patients with ILD, treated between April 2013 and March 2016, were retrospectively investigated. Carboplatin (AUC 5-6) was administered on day 1 and nab-paclitaxel on days 1, 8 and 15, every 4-6 weeks. The median age of the patients upon initiating chemotherapy was 67 years. The pathological examination revealed 6 patients with squamous cell carcinoma, and 6 patients exhibited the typical pattern of ILD. The response rate was 55.6%, and the median progression-free and overall survival time was 174 and 344 days, respectively. Acute exacerbation of ILD was not observed in any of the patients, and febrile neutropenia developed in 3 patients (3/9, 33.3%). Thus, treatment with carboplatin plus nab-paclitaxel was found to be safe and effective for NSCLC patients with ILD, although management of hematological adverse events, such as febrile neutropenia, was required. However, these encouraging results require confirmation by a large-scale clinical trial.
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Affiliation(s)
- Hideyuki Niwa
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Masanori Yokoba
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Hisashi Mitsufuji
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Jiichiro Sasaki
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Noriyuki Masuda
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
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Kobayashi H, Omori S, Nakashima K, Wakuda K, Ono A, Kenmotsu H, Naito T, Murakami H, Endo M, Takahashi T. Modified GAP index for prediction of acute exacerbation of idiopathic pulmonary fibrosis in non-small cell lung cancer. Respirology 2017; 22:1379-1385. [DOI: 10.1111/resp.13075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Haruki Kobayashi
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Shota Omori
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | | | - Kazushige Wakuda
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Akira Ono
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | | | - Tateaki Naito
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology; Shizuoka Cancer Center; Shizuoka Japan
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Effect of collagen vascular disease-associated interstitial lung disease on the outcomes of lung cancer surgery. Surg Today 2017; 47:1072-1079. [PMID: 28247107 PMCID: PMC5532416 DOI: 10.1007/s00595-017-1476-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/04/2017] [Indexed: 12/24/2022]
Abstract
Purpose This study compared the effect of collagen vascular disease-associated interstitial lung disease (CVD-ILD) with that of idiopathic interstitial pneumonias (IIPs) on the outcomes of lung cancer surgery. Methods This study retrospectively reviewed the medical records of patients who underwent surgery for non-small cell lung cancer (NSCLC) and compared the data of 16 patients with CVD-ILD with those of 70 patients with IIPs. The patterns of interstitial lung disease (ILD) on chest computed tomography were classified into usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) patterns. Results The numbers of UIP and NSIP patterns were 10 (62.5%) and 6 (37.5%) patients in CVD-ILD group, and 62 (88.6%) and 8 (11.4%) patients in IIPs group, respectively. A postoperative acute exacerbation (AE) appeared in 1 patient (6.3%) in the CVD-ILD group and 6 patients (8.6%) in the IIPs group. No significant differences in the incidence of postoperative AE and mortalities were observed between the two groups. The five-year overall survival rates of the CVD-ILD and IIPs groups were 37.5 and 49.2%, respectively. Conclusions Surgery for NSCLC in CVD-ILD patients appear to cause no increase in postoperative AE and mortality in comparison to that seen in IIPs patients. Similar to IIPs, CVD-ILD might therefore affect the prognosis of resected NSCLC.
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Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer. PLoS One 2016; 11:e0168465. [PMID: 28006019 PMCID: PMC5179067 DOI: 10.1371/journal.pone.0168465] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/01/2016] [Indexed: 11/23/2022] Open
Abstract
Background Data on characteristics, outcomes, and prognosis of advanced non-small-cell lung cancer (NSCLC) patients who develop pneumonitis during systemic anti-cancer therapy (pneumonitis) are currently lacking. Methods We conducted a retrospective cohort study of 910 consecutive patients diagnosed with advanced NSCLC between January 2004 and January 2014. Of these, 140 patients were excluded because they did not receive systemic anti-cancer therapy at this hospital. Results A total of 770 patients were included in the study, of whom 44 (6%) were diagnosed with pneumonitis. The mortality rate of pneumonitis was 36%. The incidence of pneumonitis was independently associated with pre-existing ILD (adjusted odds ratio, 2.99, P = 0.008), and survivors were significantly associated with younger age (P = 0.003) and radiographic non-acute interstitial pneumonia pattern (P = 0.004). In all patients, pneumonitis was identified as an independent predictor of overall survival (OS) (adjusted hazard ratio 1.53, 95% CI, 1.09–2.09, P = 0.015). Performance status was poor in 82% of survivors of pneumonitis; in 62% of survivors, the PS worsened after the pneumonitis improved. Additionally, 54% of survivors received no further systemic anti-cancer therapy after pneumonitis. The median survival time of survivors after pneumonitis was 3.5 months (95% CI, 2.3–7.2 months). Conclusions Our study indicated that 6% of patients with advanced NSCLC developed pneumonitis during systemic anti-cancer therapy. The early mortality rate of pneumonitis is high, and the survival and PS after pneumonitis is extremely poor. Additionally, pneumonitis has an adverse impact on the survival of patients with advanced NSCLC. These data should be considered for the management of pneumonitis, and we recommend that future work focuses on pneumonitis particularly to improve the survival of patients with advanced NSCLC.
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Safety and efficacy of S-1 in combination with carboplatin in non-small cell lung cancer patients with interstitial lung disease: a pilot study. Cancer Chemother Pharmacol 2016; 77:1245-52. [DOI: 10.1007/s00280-016-3040-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/19/2016] [Indexed: 12/14/2022]
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50
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Distinctive impact of pre-existing interstitial lung disease on the risk of chemotherapy-related lung injury in patients with lung cancer. Cancer Chemother Pharmacol 2016; 77:1031-8. [DOI: 10.1007/s00280-016-3025-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/27/2016] [Indexed: 01/01/2023]
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