Glasgow Prognostic Score predicts chemotherapy‐triggered acute exacerbation‐interstitial lung disease in patients with non‐small cell lung cancer

Abstract

Background Interstitial lung disease (ILD) in patients with non‐small cell lung cancer (NSCLC) worsens the prognosis for overall survival (OS) due to chemotherapy‐triggered acute exacerbation (AE)‐ILD. The Glasgow Prognostic Score (GPS), which is based on serum C‐reactive protein and albumin levels, has been suggested as a reliable prognostic tool for mortality in cancer patients, including NSCLC. In this study, we investigated whether GPS is a predictor for chemotherapy‐triggered AE‐ILD and the prognosis in patients with NSCLC and pre‐existing ILD. Methods We conducted a retrospective review on 56 NSCLC and ILD patients at our hospital who received platinum agent‐based treatment as first‐line chemotherapy between June 2010 and May 2019. We categorized these patients according to their GPS (0–2) and compared the incidence of chemotherapy‐triggered AE‐ILD and OS. Results The GPS 0, 1, and 2 groups included 31, 16, and nine patients, respectively, out of 56. A total of 12 (21.4%) patients showed chemotherapy‐triggered AE‐ILD. The median OS was at 11.5 months (95% confidence interval: 8.0–15.1). The incidence of chemotherapy‐triggered AE‐ILD within the first year of chemotherapy in the GPS 0, 1, and 2 groups was three (9.6%), four (25.0%), and five (55.5%), and the median OS time was 16.9, 9.8 and 7.6 months, respectively. Univariate and multivariate analyses indicated that only GPS 2 could predict both chemotherapy‐triggered AE‐ILD and OS (P < 0.05). Conclusions GPS assessment of patients with NSCLC and pre‐existing ILD is a valuable prognostic tool for predicting chemotherapy‐triggered AE‐ILD and OS. Key points Significant findings of the study We found that GPS 2 was an independent risk factor for chemotherapy‐triggered AE‐ILD and prognosis in patients with ILD associated with NSCLC. What this study adds GPS may potentially enable the discrimination of patients tolerant of chemotherapy from those at an increased risk of AE‐ILD and predict the prognosis in patients with NSCLC and ILD receiving chemotherapy.

Impact of sarcopenia on chemotherapy‐triggered exacerbation of interstitial lung disease in patients with non‐small cell lung cancer

“…35 Patients with sarcopenia have been found to have reduced PGC-1α in their skeletal muscle but enhanced interleukin-6 and tumor necrosis factor-α expression, causing inflammation and muscle proteolysis 36,37 Previous studies have suggested that inflammation and undernutrition may contribute to the prognosis and exacerbation of ILD. 14,[38][39][40][41] Based the aforementioned findings, anti-inflammatory treatment through myokine supplementation and maintenance of muscle mass through nutrition therapy and rehabilitation may be novel approaches for suppressing ILD exacerbation, as well as improving the prognosis for lung cancer with ILD.…”

“…(3) ILD that could not be completely explained by pulmonary infectious disease, heart failure, or fluid overload; and (4) a less than 4-week interval between the last chemotherapy administration and onset of ILD exacerbation. 9,10,13,14,30 The following patients were excluded: those (1) whose CT images did not include the spinous process at the third lumbar vertebral level, (2) who had other concomitant active malignancies, infectious diseases, or congested cardiac failure upon initial presentation, (3) who had insufficient clinical data, (4) who had been taking systemic steroids, (5) who had secondary ILD (i.e., interstitial pneumonia associated with connective tissue disease or antineutrophil cytoplasmic antibody-associated ILD), (6) who had received contraindicated chemotherapeutic drugs in Japan for patients with ILD (i.e., gemcitabine and epidermal growth factor receptor tyrosine kinase inhibitor), and (7) who received thoracic irradiation.…”

Impact of Sarcopenia on Chemotherapy-Triggered Exacerbation of Interstitial Lung Disease in Patients With Non-Small Cell Lung Cancer

“…First, this was a single-center retrospective study with a relatively small sample size, which may introduce bias. However, lung cancer with ILD is a rare disease with a limited number of patients 3,4,9,10,[12][13][14]38,40 . The number of patients included herein does not considerably differ from those included in other studies.…”

“…ILD was diagnosed when ground-glass attenuation and reticulation shadow or honeycombing with/without peripheral traction bronchiectasis were observed in both lung elds on chest HRCT. Diagnoses of chemotherapy-triggered ILD exacerbation were made in accordance with the following criteria detailed in previous studies: (1) deterioration of dyspnea; (2) new bilateral ground-glass attenuation and/or consolidation superimposed on pre-existing interstitial shadows; (3) ILD that could not be completely explained by pulmonary infectious disease, heart failure, or uid overload; and (4) a less than 4-week interval between the last chemotherapy administration and onset of ILD exacerbation 9,10,13,14,42 .…”

“…Although the etiology of sarcopenia remains unclear, chronic in ammation and malnutrition due to regulation of myokine production have been considered causative factors 16 . Our group had previously reported that GPS, which is calculated using serum C-reactive protein and albumin, can predict the prognosis and exacerbation of ILD in patients with ILD-complicated lung cancer 14,15 , suggesting the potential involvement of in ammation and nutrition in the pathophysiology of this disease. Therefore, the present study sought to determine whether the psoas major muscle area at the third lumbar vertebral level on CT, which has been used as an index that re ects the entire skeletal muscle mass 28 , could potentially be a biomarker for predicting exacerbation of ILD and overall survival (OS) in patients with ILD-complicated lung cancer.…”