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Real-world evaluation of second line chemotherapy for patients with advanced non-small cell lung cancer harboring preexisting interstitial lung disease

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Summary

Background. The optimal second and subsequent lines of chemotherapy for patients with non-small cell lung cancer (NSCLC) who have preexisting interstitial lung disease (ILD) are unclear. Hence, we examined the clinical efficacy and safety of second-line chemotherapy in such patients, including any exacerbation of preexisting ILD. Methods. The medical records of patients with NSCLC and preexisting ILD who received both first- and second-line chemotherapy were retrospectively reviewed. Results. Twenty-four patients with a median age of 71 years who were treated between April 2013 and March 2021 were included. The response rate after second-line chemotherapy with S-1 (n = 13), docetaxel (n = 8), pemetrexed (n = 2), or docetaxel plus ramucirumab (n = 1) was 12.5%, with a median progression-free survival (2nd line PFS) of 3.8 months. The overall survival from a start of first-line chemotherapy (1st line OS) and post-progression survival (PPS) post-first-line chemotherapy were 18.7 and 9.7 months, respectively. Spearman rank correlation and linear regression analyses showed that PPS was strongly correlated with 1st line OS (R = 0.85, P < 0.00001). Importantly, the 2nd line PFS was also significantly correlated with 1st line OS (R = 0.71, P = 0.0001). While second-line chemotherapy-related acute exacerbation of ILD was observed in 7 patients (29.2%), there were no treatment-related fatalities. Conslusions. Second-line chemotherapy has a strong positive impact on the OS of patients with NSCLC who have preexisting ILD. Given the findings of this study, second-line chemotherapy may be valuable in terms of prolonging long-term OS.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We gratefully thank the staff members of the Department of Respiratory Medicine, Kitasato University School of Medicine, for their suggestions and assistance.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan

    Satoshi Igawa, Akira Takakura, Shinji Hosotani, Yoshiro Nakahara, Takashi Sato & Katsuhiko Naoki

  2. School of Allied Health Sciences, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan

    Masanori Yokoba

  3. Kitasato University School of Nursing, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0329, Japan

    Hisashi Mitsufuji

  4. Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan

    Jiichiro Sasaki

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Contributions

All authors contributed to the study conception and design. Data collection was performed by SH and AT, and analysis was performed by SI. The first draft of the manuscript was written by SI and KN. All authors commented on versions of the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Satoshi Igawa.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Ethics Review Board of Kitasato University Hospital. The requirement for informed consent was waived owing to the retrospective nature of the study.

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Igawa, S., Yokoba, M., Takakura, A. et al. Real-world evaluation of second line chemotherapy for patients with advanced non-small cell lung cancer harboring preexisting interstitial lung disease. Invest New Drugs 40, 182–189 (2022). https://doi.org/10.1007/s10637-021-01162-x

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