Management and Prognosis of Interstitial Lung Disease With Lung Cancer (ILD-LC): A Real-World Cohort From Three Medical Centers in China

Abstract

Background and ObjectiveInterstitial 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.MethodsThe 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.ResultsOne 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.ConclusionPatients 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.

Impact of interstitial lung disease Gender-Age-Physiology index in surgically treated lung cancer

“…In our study, the 5-year OS was also poor at 40.7%. This is thought to be owing to the high risk of recurrence in ILD-LC [5,[13][14], di culty in therapeutic intervention upon recurrence [15][16], metachronous lung cancer [16], and the harmful complications resulting from treatment. However, for the ILD-LC patients treated with radiation, the mortality and ILD-speci c toxicity (de ned as grade-3 radiation pneumonitis or acute exacerbation of ILD) were 15.6% and 25%, respectively [17], with grade-5 radiation pneumonitis occurring in 2.7-16.7% [18,19].…”

“…Because of the complex interplay of the aforementioned factors, the prognosis for ILD-LC is poor. Surgery is the standard treatment because the survival rate of surgery is higher than that of other treatments for early-stage lung cancer with ILD [5], but unfortunately, some patients died owing to AE caused by surgery or respiratory failure attributed to the progression of ILD [4]. When we selected surgery for ILD-LC, it was always di cult to manage the perioperative period without complications and to judge whether patients with decreased respiratory function could tolerate it.…”

Safety profile of tyrosine kinase inhibitors used in non-small-cell lung cancer: An analysis from the Italian pharmacovigilance database

“…Fatal cases mainly involved respiratory failure and interstitial lung disease probably due to the progression of neoplasm and IV staging. A meta-analysis pointed out that patients affected by NSCLC and treated with EGFR-TKIs had a rare incidence of fatal toxic effects although the respiratory system was the most frequently involved ( 59 ). Interstitial lung disease is considered to be the most serious and fatal TKI-related ADR because the inhibition of EGFR signaling may damage the repair capability of lung cells and worsen pulmonary injury resulting in death ( 29 ).…”

Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern

“…This condition is also reportedly associated with a high risk of lung cancer; the incidence of lung cancer among patients with IPF is approximately 22.9 per 10,000 person-years 6 . Furthermore, patients with both lung cancer and IPF have poor prognosis and difficulty in proper management due to surgical morbidity and respiratory complication such as drug induced pneumonitis and acute exacerbation of IPF 7 , 8 . Patients with IPF regularly undergo chest CT for evaluation of disease progression and for the risk of developing lung cancer.…”