Real-World Evidence of Safety and Efficacy of Carboplatin plus Nanoparticle Albumin-Bound Paclitaxel in Patients with Advanced Non-Small-Cell Lung Cancer and Preexisting Interstitial Lung Disease: A Retrospective Study.

Tomoyuki Araya,Yuka Uchida,Tsukasa Ueda,Toshiyuki Kita,Kazuo Kasahara,Koji Kurokawa,Kenta Yamamura,Nanao Terada,Tamami Sakai,Hideharu Kimura,Takashi Sone

doi:10.1155/2019/5315903

Tomoyuki Araya, Yuka Uchida + Show 9 more

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https://doi.org/10.1155/2019/5315903

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Abstract

Background Standard chemotherapy for advanced non-small-cell lung cancer (NSCLC) with preexisting interstitial lung disease (ILD) has not yet been established. Although a combination of carboplatin and paclitaxel is most frequently used for patients with advanced NSCLC and ILD, the safety and efficacy of carboplatin plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel) are yet to be elucidated. Objectives This study aimed to evaluate the safety and efficacy of carboplatin plus nab-paclitaxel for advanced NSCLC with ILD. Methods This retrospective study included nine patients with advanced NSCLC and ILD who received carboplatin plus nab-paclitaxel as first-line chemotherapy at the National Hospital Organization Kanazawa Medical Center between April 2013 and December 2017. The ILD-GAP index was used to evaluate mortality risk of baseline ILD. Results A usual interstitial pneumonia (UIP) pattern of ILD was observed in five (55.6%) patients on their baseline high-resolution computed tomography (HRCT) scans. The median ILD-GAP index was 4 (range, 1–5), and six (66.7%) patients had ILD-GAP index ≥4. We observed no ILD exacerbations or chemotherapy-related deaths. The overall response and disease control rates were 77.8% (95% CI, 40.0–97.2) and 88.9% (95% CI, 51.8–97.2), respectively. The median progression-free survival and overall survival were 5.8 months (95% CI, 2.1–7.7) and 8.0 months (95% CI, 2.6–16.8), respectively. Conclusions Carboplatin plus nab-paclitaxel showed favorable safety and efficacy in patients who had advanced NSCLC and ILD with a high risk of mortality. Prospective studies are required to further confirm these results.

Highlights

Lung cancer is the leading cause of cancer-related mortality worldwide [1]
Patients with advanced non-small-cell lung cancer (NSCLC) with interstitial lung disease (ILD) have been excluded from clinical trials and, no standard chemotherapy regimen has been established for such patients
Two radiologists and two pulmonologists evaluated the chest high-resolution computed tomography (HRCT) findings of our patients and classified ILD patterns according to the absence or presence of a typical usual interstitial pneumonia (UIP) pattern based on Fleischner Society White Paper and the ATS/ERS/JRS/ALAT 2018 [15, 16]. e ILD-GAP index, based on gender (G), age (A), and two lung physiology variables (P, forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLco)), which is a previously validated risk prediction method in patients with chronic interstitial lung disease [17], was used to evaluate the mortality risk of baseline ILD

Summary

Introduction

Lung cancer is the leading cause of cancer-related mortality worldwide [1]. Interstitial lung disease (ILD), a critical problem in the treatment of lung cancer, is observed in 5.8–15.2% of patients with lung cancer at diagnosis [2, 3]. Standard chemotherapy for advanced non-small-cell lung cancer (NSCLC) with preexisting interstitial lung disease (ILD) has not yet been established. A combination of carboplatin and paclitaxel is most frequently used for patients with advanced NSCLC and ILD, the safety and efficacy of carboplatin plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel) are yet to be elucidated. Is study aimed to evaluate the safety and efficacy of carboplatin plus nab-paclitaxel for advanced NSCLC with ILD. Is retrospective study included nine patients with advanced NSCLC and ILD who received carboplatin plus nab-paclitaxel as first-line chemotherapy at the National Hospital Organization Kanazawa Medical Center between April 2013 and December 2017. Carboplatin plus nab-paclitaxel showed favorable safety and efficacy in patients who had advanced NSCLC and ILD with a high risk of mortality.

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Conclusion