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Exploring Efficacy and Safety of Second-Line Chemotherapy in Advanced NSCLC With Interstitial Lung Disease
Second-line chemotherapy among patients with non-small cell lung cancer (NSCLC) complicated by interstitial lung disease (ILD) revealed a certain effectiveness, but some patients experienced the adverse effects (AE) of ILD, which may lead to death. Moreover, the risk of the AE of ILD must be considered especially for patients with usual interstitial pneumonia (UIP) and low percentage vital capacity (VC; Thorac Cancer. 2022; doi: 10.1111/1759-7714.14645).
Kenji Otsuka, MD, Department of Respiratory Medicine and Rheumatology Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan, and colleagues investigated the efficacy and safety of second-line chemotherapy for NSCLC patients with ILD and retrospectively reviewed patients who were treated at their institute between April 2010 and December 2018.
Results revealed that 35 patients received two or more regimens with 34 patients being male and the median age at the initiation of second-line chemotherapy was 70 years. Almost all patients had a history of smoking and 14 patients had adenocarcinoma and 15 had squamous cell carcinoma histology. Stages III and IV were observed in 20 and 11 patients, respectively.
With regard to the type of ILD, 12 patients had usual interstitial pneumonia (UIP) and the overall response rate and disease control rate were 11.4 and 68.6%, respectively. The median progression-free and median overall survival were 4.1 and 6.4 months, respectively. The AE of ILD was observed in eight patients, five of whom died. UIP and low percentage vital capacity were identified as significant risk factors for the AE of ILD.
The authors noted that their study was associated with some limitations, including the relatively small number of patients and the single center setting. Therefore, a large-scale prospective study is needed to assess the efficacy and safety of second-line chemotherapy for patients with LC complicated by ILD.
The authors concluded, “Our retrospective data suggest that chemotherapy for patients with NSCLC complicated by ILD is effective in the second-line setting; however, we have to consider the risk of the AE of ILD, especially in patients with the UIP pattern and low percentage VC.”
