Abstract
ObjectiveLung cancer frequently co-exists with idiopathic interstitial pneumonia (IIP), which can be subdivided into idiopathic pulmonary fibrosis (IPF) and IIP other than IPF (other IIP). Although chemotherapy in small cell lung cancer (SCLC) patients with IIP may result in the exacerbation of IIP, these patients commonly receive chemotherapy. This study aimed to assess the risks and benefits of chemotherapy in SCLC patients with IIP.MethodsWe retrospectively analyzed the medical records of 122 patients with SCLC who received chemotherapy. Patients with secondary interstitial lung disease (ILD) of known etiology were excluded. Eligible patients were divided into two groups: SCLC with and without IIP. The former group was subdivided into those with IPF and other IIP.ResultsOf the 47 (39.2%) SCLC patients with IIP, 20 had IPF and 27 had other IIP. The frequency of chemotherapy-induced ILD development or IIP exacerbation was higher in patients with IPF (40.0%) than in those with other IIP (3.7%) and non-IIP (1.4%). Logistic regression analysis demonstrated that ILD development or IIP exacerbation was independently associated with IPF (P = 0.007). Time to treatment failure (P < 0.001) and overall survival (P = 0.001) were different among the groups., Cox proportional hazard model revealed that IPF was independently associated with time to treatment failure (P = 0,017) and overall survival (P = 0.006). Other IIP had no impact on time to treatment failure or overall survival. Development of ILD or exacerbation of IIP independently reduced time to treatment failure and overall survival.ConclusionsComorbid IPF can be an independent, negative prognostic indicator and at high risk of ILD development or IIP exacerbation in SCLC patients. Early diagnosis and intervention for chemotherapy-induced IIP exacerbation will be beneficial for SCLC patients with IPF, who need close monitoring for its onset.
Highlights
Interstitial lung diseases (ILD) are a heterogeneous group of diffuse parenchymal lung diseases with a variety of etiologies, which include genetic predisposition and environmental factors
The frequency of chemotherapy-induced interstitial lung disease (ILD) development or interstitial pneumonia (IIP) exacerbation was higher in patients with idiopathic pulmonary fibrosis (IPF) (40.0%) than in those with other IIP (3.7%) and non-IIP (1.4%)
Logistic regression analysis demonstrated that ILD development or IIP exacerbation was independently associated with IPF (P = 0.007)
Summary
Interstitial lung diseases (ILD) are a heterogeneous group of diffuse parenchymal lung diseases with a variety of etiologies, which include genetic predisposition and environmental factors. According to the American Thoracic Society ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society (JRS), idiopathic interstitial pneumonia (IIP) of unknown etiology is a form of ILD, and it is further subdivided into multiple disease categories [1]. Out of these categories, usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) accounts for 80–90% of IIP cases, and patients with IPF has a poor prognosis, with a median survival time of 3–5 years [2,3,4,5]. Anti-cancer treatments, such as chemotherapy, thoracic radiation, and surgical resection, may result in an exacerbation of IIP, which raises the question of whether patients with the comorbidity of lung cancer and IIP should be treated with these therapeutic modalities
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