Analysis of advanced lung cancer patients diagnosed following emergency admission

Fujimoto, Daichi; Shimizu, Ryoko; Morimoto, Takeshi; Kato, Ryuichi; Sato, Yuki; Kogo, Mariko; Ito, Jiro; Teraoka, Shunsuke; Otoshi, Takehiro; Nagata, Kazuma; Nakagawa, Atsushi; Otsuka, Kojiro; Katakami, Nobuyuki; Tomii, Keisuke

doi:10.1183/09031936.00068114

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…In general, PS is the most important factor for evaluating the prognosis and appropriateness of systemic anti-cancer therapy in patients with advanced NSCLC. The benefits of systemic anti-cancer therapy are speculative and the prognosis is poor in patients with poor PS [29–33]. For the management of patients with pneumonitis, we should consider the prognosis and potential worsening of the patient’s condition after pneumonitis in order to make the most appropriate shared decisions [34, 35].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer

et al. 2016

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BackgroundData 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.MethodsWe 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.ResultsA 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).ConclusionsOur 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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Section: Discussionmentioning

confidence: 99%

Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer

et al. 2016

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“…What's more, airway stenting gives time for adjuvant chemoradiotherapy to take effect, possibly leading to prolonged survival. The patient's PS improved significantly after stenting and a good PS score was an independent predictor of prolonged overall survival prior to chemotherapy (11). Although combination chemotherapy is associated with clinical improvement in patients with advanced non-small cell lung cancer of poor PS (12), PS is less important to targeted therapy.…”

Section: A B C D E Fmentioning

confidence: 99%

Rapid response in a critical lung adenocarcinoma presenting as large airway stenoses after receiving stent implantation and sequential rebiopsy guided ALK inhibitor therapy: a case report

et al. 2017

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Airway stent implantation can improve the symptoms of airway stenosis caused by a malignant tumor immediately. However, stent implantation is only a palliative therapy and disease will quickly progress without subsequent treatment. Targeted therapy can provide accurate etiological treatment for patients with critical lung cancer who cannot receive chemotherapies. In our clinic, we encountered a 50-year-old male presenting with stage IV lung adenocarcinoma. He failed both the first-line and second-line chemotherapies and suffered severe complex left and right main bronchial stenoses caused by tumor invasion. An emergency stent was implanted to relieve dyspnea symptoms. At nearly the same time, he was detected to have an ALK gene fusion mutation upon rebiopsy and subsequently began crizotinib therapy. A short time later his obstructed airway returned to normal and lesions in the lung were miraculously reduced. This case indicates that the combination of stent implantation and real-time rebiopsy guided targeted therapy brings a new hope for patients with critical lung cancer. J Thorac Dis 2017;9(3):E230-E235 jtd.amegroups.com in another hospital. His biopsy specimen was acquired by TBNA and ALK status was detected by means of Ventana immunohistochemistry (IHC). He had received five cycles of combination chemotherapies containing carboplatin and pemetrexed and three cycles of combination chemotherapies containing gemcitabine and nedaplatin in that hospital. On arrival (D0), he was in respiratory distress with a respiratory rate of 28 bpm and oxygen saturation of 88-89% without oxygen inhalation. Physical examination was remarkable for scattered rhonchi and decreased breath sounds over both the lung fields. His performance status (PS) was grade 4 (Zubrod-ECOG-WHO score). A chest CT scan at the local hospital showed that the primary lesion had become lager, exacerbating both left and right main bronchial stenoses.Six days later, on D6, he underwent interventional therapy through flexible bronchoscope (FB) (Figure 1). We observed a large new lesion in the carina which was a typical aspect of the invasion of the two main stems bronchi from the mediastinum by the invasion of International Association for the Study of Lung Cancer (IASLC) lymph node station 7. The right main bronchus was completely occluded. We used argon plasma coagulation (APC) to treat the bleeding in the right main bronchus and rebiopsied the neoplasm in the left main bronchus. The neoplasm was then taken for pathologic examination and mutational analyses were completed for EGFR, ALK and ROS1 genes. On D10, under local anaesthesia, he was examined by FB again. We could see the left main bronchial stenosis was slightly relieved while right main bronchus was still obstructed by tumor tissue. We inserted a stent in the left main bronchus through the work way of FB and under its direct vision. When the airway stent was released, we adjusted its position with biopsy forceps and then dilated the airway with a balloon catheter. At last, the stent op...

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“…Most cases are encountered in the unresectable and metastatic stage at the initial diagnosis (2). Furthermore, previous studies (3,4) have reported that 13%-40% of patients with lung cancer were diagnosed following emergency admission (DFEA). Fujimoto et al (3) also reported that the performance status (PS) in the emergency department was not an independent predictor of the overall survival, while improvement of PS and epidermal growth factor receptor (EGFR) mutation positivity were independent predictors of overall survival.…”

Section: Introductionmentioning

confidence: 99%

Utility of Endoscopic Ultrasound with Bronchoscope-guided Fine-needle Aspiration for Detecting Driver Oncogenes in Non-small-cell Lung Cancer during Emergency Situations: Case Series

Nakashima

Demura

et al. 2021

Intern. Med.

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Since it is difficult to obtain tumor tissue via airway observation for lung cancer patients with a poor respiratory condition, endoscopic ultrasound with bronchoscope-guided fine-needle-aspiration (EUS-B-FNA), a transesophageal procedure, is effective for such patients. We herein report three patients with driver oncogenes taken to the emergency department because of lung cancer-related symptoms. EUS-B-FNA was performed because of the patients' poor respiratory conditions to detect driver oncogenes. The general conditions improved, and the patients achieved a long-term survival with tyrosine kinase inhibitors. Our findings suggest that EUS-B-FNA should be considered to detect driver oncogenes in lung cancer patients despite poor respiratory conditions in emergency departments.

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Analysis of advanced lung cancer patients diagnosed following emergency admission

Cited by 14 publications

References 35 publications

Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer

Characteristics and Prognostic Impact of Pneumonitis during Systemic Anti-Cancer Therapy in Patients with Advanced Non-Small-Cell Lung Cancer

Rapid response in a critical lung adenocarcinoma presenting as large airway stenoses after receiving stent implantation and sequential rebiopsy guided ALK inhibitor therapy: a case report

Utility of Endoscopic Ultrasound with Bronchoscope-guided Fine-needle Aspiration for Detecting Driver Oncogenes in Non-small-cell Lung Cancer during Emergency Situations: Case Series

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