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

Fumiyuki Takahashi,Naoko Shimada,Kentaro Suina,Tetsuhiko Asao,Kazuhisa Takahashi,Ryo Koyama,Ryota Kanemaru,Yuichiro Honma,Keiko Muraki,Takehito Shukuya,Koji Sugano,Motoyasu Kato,Keita Mori,Rina Shibayama

doi:10.1186/1471-2407-14-508

Fumiyuki Takahashi, Naoko Shimada + Show 12 more

Open Access

https://doi.org/10.1186/1471-2407-14-508

Copy DOI

Journal: BMC cancer	Publication Date: Jul 10, 2014
Citations: 57	License type: cc-by

Affiliation: Juntendo University, Shizuoka Cancer Center

Abstract

BackgroundNon-small cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) need to be approached carefully given the high incidence of pulmonary toxicity. Pemetrexed (PEM) is the key drug for the treatment of NSCLC. However, its safety, especially with respect to the exacerbation of ILD, and efficacy in NSCLC patients with ILD have yet to be established.MethodWe investigated the safety and efficacy of PEM monotherapy in NSCLC patients with or without idiopathic interstitial pneumonia (IIPs). The medical charts of these patients were retrospectively reviewed.ResultsTwenty-five patients diagnosed as having IIPs (IIPs group) and 88 patients without ILD (non-ILD group) were treated with PEM monotherapy at Juntendo University Hospital between 2009 and 2013. In the IIPs group, 12 patients were found to have usual interstitial pneumonitis (UIP) on chest computed tomography (CT) (UIP group) and the other 13 patients showed a non-UIP pattern on chest CT (non-UIP IIPs group). Three patients in the IIPs group (2 in the UIP group and 1 in the non-UIP IIPs group) and 1 in the non-ILD group developed pulmonary toxicity during treatment (3.5% overall, 12.0% in the IIPs group versus 1.1% in the non-ILD group). Moreover, all 3 patients in the IIPs group died of pulmonary toxicity. Overall survival tended to be longer in the non-ILD group than in the IIPs group (p = 0.08). Multivariate analyses demonstrated that IIPs was the only significant independent risk factor for PEM-related pulmonary toxicity.ConclusionWe found that the incidence of PEM-related pulmonary toxicity was significantly higher amongst NSCLC patients with IIPs than among those without IIPs. Particular care must be taken when administering PEM to treat NSCLC patients with IIPs.

Highlights

Non-small cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) need to be approached carefully given the high incidence of pulmonary toxicity
Twenty-five patients diagnosed as having interstitial pneumonitis (IIPs) (IIPs group) and 88 patients without ILD were treated with PEM monotherapy at Juntendo University Hospital between 2009 and 2013
We found that the incidence of PEM-related pulmonary toxicity was significantly higher amongst NSCLC patients with IIPs than among those without IIPs

Summary

Introduction

Non-small cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) need to be approached carefully given the high incidence of pulmonary toxicity. Lung cancer is a pulmonary disease with a poor prognosis, and is frequently associated with interstitial lung disease (ILD), especially idiopathic interstitial pneumonitis (IIPs). It has been reported that the prevalence of idiopathic pulmonary fibrosis (IPF) in the United States and Japan were estimated to be 14.0 to 42.7 and 3.44 per 100,000 people, respectively [3,4] It is unknown whether the prevalence of IPF and prevalence of lung cancer in IPF patients are influenced by ethnic, geographic or cultural factors or not, because there are no reports on direct comparison of incidence and prevalence rate between Caucasian and Japanese [5]

Methods

Results

Discussion

Conclusion