Chemotherapy for non-small cell lung cancer complicated by idiopathic interstitial pneumonia

Abstract

Abstract. Idiopathic interstitial pneumonia (IIP) is considered to be one of the risk factors for lung cancer (LC). However, therapeutic options for patients with LC complicated by IIP are not well established. In this study, we investigated the feasibility and efficacy of chemotherapy for patients with non-small cell lung cancer (NSCLC) complicated by IIP (NSCLC-IIP). We retrospectively analyzed 22 NSCLC-IIP patients who received chemotherapy. To determine how IIP affected the clinical outcomes in NSCLC, they were compared with 276 NSCLC patients without IIP, who were treated with chemotherapy alone. The response rate (partial response + stable disease) was 72.3% (17/22), whereas the incidence of acute exacerbation (AE) was 13.6% (3/22) in NSCLC-IIP patients treated with chemotherapy. NSCLC-IIP patients had significantly shorter survival compared with NSCLC patients without IIP (P<0.001) following chemotherapy, although the response rates to chemotherapy were not significantly different between the two groups. Multivariate analysis demonstrated that, in NSCLC patients receiving chemotherapy, IIP was a significantly unfavorable factor for progression-free and overall survival. Despite similar response rates to chemotherapy, NSCLC-IIP patients showed poorer prognosis than NSCLC patients without IIP, possibly due to the natural course of IIP. Chemotherapy may be a feasible option for NSCLC-IIP, if the risks of adverse effects are acceptable.

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

“…These were similar to the results of previous reports [36–38]. In our study, we performed a subgroup analysis of 69 patients with pre-existing ILD.…”

Interstitial lung abnormalities in treatment-naïve advanced non-small-cell lung cancer patients are associated with shorter survival

“…Kinoshita et al studied idiopathic interstitial pneumonia (IIP), diagnosed based on histological diagnosis of UIP or nonspecific interstitial pneumonia (NSIP), or radiological and/or clinical diagnosis of IPF. Among stage III, IV or recurrent lung cancer patients treated with chemotherapy alone, 22 patients with IIP had significantly shorter overall and progression-free survival compared to 276 patients without IIP, which shares similarity with our results 15 . In their study, IIP was diagnosed based on histological diagnosis of UIP or NSIP, or radiological and/or clinical diagnosis of IPF; other interstitial lung diseases that many manifest similar radiologic findings such as connective tissue disorders and hypersensitivity pneumonitis were excluded.…”

“…Some prior reports have identified the similarities between the pathogenesis of interstitial lung diseases and smoking-related carcinogenesis, in the aspects of oxidative stress, mutagenesis, angiogenesis, and epithelial to mesenchymal transformation 2, 10, 11 . It is also well established that interstitial lung diseases may be exacerbated in lung cancer patients after local or systemic therapy which can adversely impact the clinical outcome 12-15 . However, the prevalence of interstitial lung diseases at the time of diagnosis and prior to initiation of treatment and the impact on survival among advanced lung cancer patients have not been systematically investigated.…”

Impact of Pretreatment Interstitial Lung Disease on Radiation Pneumonitis and Survival after Stereotactic Body Radiation Therapy for Lung Cancer

“…The presence of ILD was an unfavorable prognostic factor for patients with NSCLC treated with surgery or chemotherapy, [22][23][24]44 as with our results. However, no difference was observed in the incidence of DP or LP between the ILD(+) and ILD(−) groups.…”

“…20,45 The response to chemotherapy was reported to be identical in those with and without ILD. 44 These results suggest that the poor prognosis in ILD(+) patients after treatment should be ascribed to the ILD itself. However, in our result, 3-year OS rate in the ILD(+) group was as high as 53.8%.…”