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

Abstract

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.

Efficacy and safety of nivolumab in non‐small cell lung cancer with preexisting interstitial lung disease

“…The ILD comorbidity rate in our study was 12%, which is comparable to the previously reported incidence of radiographic interstitial abnormality in patients with NSCLC . Considering the higher incidence of comorbidity with ILD in the Japanese population, the incidence of preexisting ILD was reasonable in this study . Finally, this cohort only consisted of Japanese patients.…”

“…Patients with interstitial lung disease (ILD) have a twofold higher risk of developing lung cancer than smokers without ILD or chronic obstructive pulmonary disease (COPD) . Lung cancer patients with ILD have few treatment options because surgery, radiotherapy, and chemotherapy elevate the risk of exacerbation of ILD …”

“…Treatment‐related pneumonitis is relatively common in Japanese patients with lung cancer . In Japan, during treatment for advanced or recurrent lung cancer, the incidence of pneumonitis induced by cytotoxic chemotherapies and molecular targeted agents are reported to be 2–6% and 3.5–4.5%, respectively . The mortality rate of chemotherapy‐related pneumonitis is reported as approximately 30% and is believed to be the most common cause of treatment‐related death .…”

“…The mortality rate of chemotherapy‐related pneumonitis is reported as approximately 30% and is believed to be the most common cause of treatment‐related death . Moreover, incidence and mortality rates of treatment‐related pneumonitis are higher in patients with preexisting ILD …”

PD‐1 inhibitors for non‐small cell lung cancer patients with special issues: Real‐world evidence

“…ILD is present in about 15% of patients at their initial diagnosis of lung cancer, and is considered to limit the effectiveness of lung cancer treatment . Conventional platinum‐based chemotherapy can acutely exacerbate ILD .…”