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

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.

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

“…In our analysis, patients with SCC accounted for a relatively high proportion, especially in the nab-PTX group (Table 1). Therefore, some studies have selection bias (34,35,37) and caused ORR in our analysis to be significantly higher than patients without ILD.…”

“…Patients in each study had similar average age and sex ratio. Of the 21 studies, 8 studies ( 15 , 23 , 26 , 28 , 29 , 32 , 33 , 38 ) mainly administered carboplatin + paclitaxel, 7 studies ( 13 , 14 , 25 , 30 , 34 , 35 , 37 ) administered carboplatin + nab-paclitaxel, 2 studies ( 16 , 24 ) administered carboplatin + S-1, 1 study ( 27 ) administered cisplatin + vinorelbine, 1 study ( 31 ) administered cisplatin + etoposide, 1 study ( 36 ) administered platinum + pemetrexed, and 1 study ( 39 ) administered carboplatin + pemetrexed/gemcitabine. Six prospective studies ( 13 – 16 , 23 , 24 ) included 237 patients.…”

“…Chemotherapy is still the main treatment regimen for NSCLC patients with preexisting ILD. A series of studies (13)(14)(15)(16)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) have investigated the risk and benefit of chemotherapy for NSCLC-ILD; however, all of these studies are single-arm trials, and part of them have a small sample size. Therefore, it is necessary to summarize the existing data to provide a basis for future clinical studies.…”

“…Second, we included many retrospective studies that may produce selective bias, and more high-quality studies are needed to verify our results in the future. Third, three studies had small sample sizes (34,35,37) and might cause heterogeneity. However, no statistical heterogeneity was observed.…”

Pemetrexed Plus Platinum for Patients With Advanced Non-small Cell Lung Cancer and Interstitial Lung Disease

“…Therefore, there is need to carefully assess whether pemetrexed containing regimens can become feasible treatment options as first-line chemotherapy for nonsquamous NSCLC patients with preexisting ILD. Paclitaxel containing regimens are the most common and well evaluated first line regimens for advanced NSCLC with preexisting ILD (16)(17)(18)(19). Minegishi et al have conducted a prospective study of paclitaxel plus carboplatin doublet chemotherapy for advanced NSCLC and preexisting ILD, and showed that the median PFS and the median OS were 5.3 months and 10.6 months, respectively (16).…”