Chemotherapy for advanced non-small cell lung cancer with interstitial lung disease.

Abstract

e18122 Background: The treatment of lung cancer with interstitial lung disease (ILD) is challenging because the treatment, including surgery, chemotherapy, and radiotherapy, can itself induce interstitial pneumonia (IP) or exacerbate preexisting ILD. Usually, clinicians hesitate to treat lung cancer with ILD. Information on the treatment of non-small cell lung cancer (NSCLC) with comorbid ILD is extremely limited; additionally, it is not known whether chemotherapy is beneficial in advanced NSCLC patients with ILD, because most clinical trials exclude patients with ILD. Methods: We retrospectively reviewed the medical records of chemotherapy-treated advanced NSCLC patients with comorbid ILD, including idiopathic interstitial pneumonia (IIP), collagen vascular disease interstitial pneumonia (CVD-IP), pneumoconiosis, and pulmonary sarcoidosis at our institution between April 1998 and March 2007 and evaluated the overall survival and acute exacerbation rates. Results: Forty cases were treated with chemotherapy and the median overall survival was 17.5 months (95% confidence interval 15.2–19.9), which is comparable with that for advanced NSCLC without ILD. Multivariate analysis revealed that poor performance status (PS) and an elevated serum KL-6 level predicted a poor overall survival. Five cases (13%) developed an acute exacerbation of preexisting ILD during treatment and two of these patients died of the exacerbation (5%). Acute exacerbation occurred not only in IIP but also in CVD-IP and pneumoconiosis. Conclusions: Chemotherapy might have survival benefit in some NSCLC patients, even with comorbid ILD. However, to treat this safely, it is necessary to avoid those patients at a high risk of acute exacerbation (poor PS, elevated serum KL-6). To determine the efficacy of chemotherapy in NSCLC patients with a good PS, normal KL-6, and comorbid ILD, further prospective study is needed. No significant financial relationships to disclose.