Impact of idiopathic pulmonary fibrosis on advanced non-small cell lung cancer survival

Abstract

Purpose The clinical features of patients with advanced non-small cell lung cancer (NSCLC) and interstitial lung disease (ILD) have not fully been elucidated. This study aimed to investigate the clinical features of these patients, particularly with idiopathic pulmonary fibrosis (IPF).Methods Data on 218 patients with pathologically confirmed diagnoses of NSCLC who had been treated with chemotherapy and/or molecular targeted therapy were retrospectively analyzed for progression-free survival (PFS), overall survival (OS), responses to first-line therapy, and incidence of acute exacerbations (AEs).ResultsFifty-three of the 218 patients were diagnosed with ILD, and 34 of them with IPF. The frequency of epidermal growth factor receptor (EGFR) mutation was significantly lower in ILD and IPF patients than in non-ILD patients (2 or 0 vs. 32 %, respectively). Median PFS and OS were significantly shorter in both ILD and IPF patients than in non-ILD patients (118, 92, and 196 days for PFS, and 267, 223, and 539 days for OS, respectively). Multivariate analysis showed that poor performance status, absence of EGFR mutation, and presence of IPF were poor prognostic factors for PFS and OS. Disease control rate (DCR) was significantly lower in ILD and IPF patients than in non-ILD patients regardless of the presence of EGFR mutation (67 or 53 vs. 85 %, respectively). The incidence of AEs of ILD was significantly higher during chemotherapy with docetaxel-containing regimens (seven of 38; 18.4 %).ConclusionsBoth IPF and ILD were associated with lower EGFR positivity, lower DCR, and shorter PFS and OS in advanced NSCLC patients.

Efficacy and safety of nivolumab in non‐small cell lung cancer with preexisting interstitial lung disease

“…In the total cohort, the incidence of nivolumab‐related ILD was significantly higher in men and patients with preexisting ILD. These factors are reported to be potential risk factors of pneumonitis in patients treated with cytotoxic chemotherapies . In the ILD group, we could not determine the risk factor responsible for the incidence and severity of nivolumab‐related pneumonitis.…”

“…28 Another pilot trial reported similar favorable efficacy of nivolumab in patients with NSCLC and ILD, and demonstrated a high RR of 50%. 29 One reason for the efficacy of nivolumab in the ILD group may be the high proportion of patients without EGFR mutations or with a smoking history (as evidenced in patients with NSCLC and ILD), 27 which appeared to be associated with a better treatment outcome in patients treated with ICIs. 28,30 Another explanation may be the tumor mutation burden, as a high tumor mutation burden is associated with a better response to nivolumab.…”

“…We compared the incidence, severity, time to onset, immunosuppressant treatment, and outcome of nivolumab‐related pneumonitis in patients with and without preexisting ILD who developed nivolumab‐related pneumonitis. We also compared the potential risk factors of pneumonitis (smoking, ECOG‐PS, and the radiographic pattern of preexisting ILD) between patients with and without nivolumab‐related pneumonitis in all patients and in the ILD group …”

“…We also compared the potential risk factors of pneumonitis (smoking, ECOG-PS, and the radiographic pattern of preexisting ILD) between patients with and without nivolumab-related pneumonitis in all patients and in the ILD group. 8,27 Statistics Continuous data are presented as the mean and range, and comparisons were made using Student's t or Mann-Whitney U tests. Categorical data were obtained as counts and percentages, and Fisher's exact tests were used to compare variables.…”

Morphologic and molecular study of lung cancers associated with idiopathic pulmonary fibrosis and other pulmonary fibroses

“…Moreover chemotherapy can also be deleterious [5, 9]. However, over the past decade a better knowledge of lung cancer biology led to major changes in the management of lung cancer patients.…”