Successful empirical erlotinib treatment of a mechanically ventilated patient newly diagnosed with metastatic lung adenocarcinoma

Bosch-Barrera, Joaquim; Sais, Elia; Lorencio, C.; Porta, Rut; Izquierdo, Àngel; Menéndez, Javier A.; Brunet, Joan; Sirvent, Josep Maria; Rosell, Rafael

doi:10.1016/j.lungcan.2014.07.010

Cited by 30 publications

(20 citation statements)

References 20 publications

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“…Our data, and others, have shown that the use of targeted TKIs combined with antibiotics and best critical care practice can result in extubation and improved OS in appropriately selected patients. 12,13 We have also shown that using second-generation TKIs in the ICU can prove useful even in those with disease refractory to first-generation therapy. Therefore, we recommend the empiric use of molecular targeted therapy for NSCLC patients with suspected and/or known actionable mutations presenting to the ICU with multi-factorial respiratory failure, with aggressive determination of mutation status if not previously known.…”

Section: Discussionmentioning

confidence: 98%

“…12,13 Although the benefit of chemotherapy for hematologic malignancies in the ICU has previously been explored, 14 few data are available regarding the use of molecular therapy in NSCLC in this setting. The primary objective of the present study was to report our institution's experience in the management of acute respiratory failure in those NSCLC patients with actionable mutations who received TKI therapy in the ICU.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Lung Cancer Patients With Actionable Mutations in the Intensive Care Unit

Kerrigan

Shoben

2016

Clinical Lung Cancer

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Lung cancer patients with acute respiratory failure in the intensive care unit have a poor prognosis. Molecular targeted therapy, in concert with best critical care practices, can result in extubation and improved performance status and overall survival in these patients. Empiric molecular targeted therapy should be considered in this setting for those patients with a high likelihood of having an activating mutation. Background Patients with advanced-stage non–small-cell lung cancer (NSCLC) have high mortality rates in the intensive care unit (ICU). Although the benefit of chemotherapy for hematologic malignancies in the ICU has previously been explored, few data exist regarding the use of targeted therapy for NSCLC in such settings. The primary objective of the present study was to report our experience with the use of targeted therapy in patients with NSCLC in the ICU. Materials and Methods We performed a single-institution, retrospective medical record review. The eligibility criteria included patients with NSCLC with targetable mutations who had received tyrosine kinase inhibitors (TKIs) in the ICU. Cases were identified by queries of our institution's information warehouse database and pharmacy dispensary records from 2010 to 2015. Results All 9 patients who had received TKIs in the ICU had acute respiratory failure. Three patients were successfully extubated after initiating TKI therapy, although 1 required later tracheostomy. TKI therapy stabilized another patient's refractory disseminated intravascular coagulation. The remaining 5 patients showed no measurable clinical improvement and were transitioned to comfort care. The overall ICU mortality rate was 56%. Conclusion Patients with metastatic NSCLC requiring mechanical ventilation have high mortality rates. Cytotoxic chemotherapy is generally contraindicated for poor performance status patients. However, targeted TKI therapy should be considered, given its proven efficacy and few systemic side effects. We recommend the empiric use of targeted therapy for NSCLC patients with suspected and/or known actionable mutations presenting with multifactorial respiratory failure to the ICU, with aggressive determination of the mutation status if not known.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Treatment of Lung Cancer Patients With Actionable Mutations in the Intensive Care Unit

Kerrigan

Shoben

2016

Clinical Lung Cancer

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“…This result likely occurred because (1) the severity of the disease is the primary determinant of prognosis in critically ill lung cancer patients, not the cancer itself and (2) of these 12 patients accepting rescue targeted therapy, five without oncogenic mutation and one unknown mutation patient received EGFR-TKIs. Attending physicians adopted the strategy of "shoot first, ask later" [17,28] because they expected that EGFR-TKIs would benefit the status of adenocarcinoma, non-smokers, and East Asian patients [29].…”

Section: Song Et Al Have Demonstrated the Number Of Advanced Lung Camentioning

confidence: 99%

Etiologies of delayed diagnosis and characteristics of patients with newly diagnosed advanced lung cancer initially presented with respiratory failure

Tseng

Shen

Lin

et al. 2020

Preprint

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Objective This study aimed to evaluate the characteristics of patients with newly diagnosed advanced lung cancer who initially presented with respiratory failure. Methods A retrospective study analyzed the outcome of patients in the intensive care unit (ICU) with newly diagnosed advanced lung cancer placed on mechanical ventilation (MV). We defined newly-diagnosed lung cancer as pathological or molecular results for treatment decisions not being out when the patient was admitted to ICU. Results During the 14-year inclusion period, 845 lung cancer patients requiring MV were screened. 56 newly diagnosed extensive lung cancer patients were analyzed. Cancer-related to central airway obstruction (n=29, 51.8%) was the leading cause of respiratory failure. The significant etiologies of delay in the diagnosis of lung cancer were diagnostic error, mistaking the cancer for tuberculosis, and missed hilar lesion. The 6-month survival was only 7.1% (n=4). SOFA score was significantly associated with mortality (HR = 1.144, 95% CI = 1.014-1.291, p = 0.028). The 6-month survival rate in patients receiving suitable targeted therapy and accepting chemotherapy and best supportive care was 40%(2/5), 0%(0/7), and 4.5%(2/44), respectively. Conclusions Patients with newly diagnosed advanced lung cancer with acute life-threatening respiratory failure have poor outcomes. Cancer-related to central airway obstruction is a leading cause of respiratory failure. Diagnostic error as tuberculosis and missed hilar lesions are two main etiologies of delay in the diagnosis. The SOFA score is correlated with mortality. For patients with oncogenic mutation adenocarcinoma, after survival from critical condition, targeted therapy can raise their six month survival rates.

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“…Only two survived for >200 days. However, the introduction of targeted therapies with a rapid and very high response rate changed our pessimistic view, with case reports [97,98] suggesting major activity of TKIs in patients with oncogenic driver mutations and respiratory failure, who were also on mechanical ventilation. The largest retrospective case-control study [90] included 14 patients with epidermal growth factor receptor mutation or anaplastic lymphoma kinase or ROS-1 rearrangements.…”

Section: Advanced Lung Cancer and Systemic Anticancer Treatment Durinmentioning

confidence: 99%

Intensive care in thoracic oncology

et al. 2017

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The admission of lung cancer patients to intensive care is related to postprocedural/postoperative care and medical complications due to cancer or its treatment, but is also related to acute organ failure not directly related to cancer.Despite careful preoperative risk management and the use of modern surgical and anaesthetic techniques, thoracic surgery remains associated with high morbidity, related to the extent of resection and specific comorbidities. Fast-tracking processes with timely recognition and treatment of complications favourably influence patient outcome. Postoperative preventive and therapeutic management has to be carefully planned in order to reduce postoperative morbidity and mortality.For patients with severe complications, intensive care unit (ICU) mortality rate ranges from 13% to 47%, and hospital mortality ranges from 24% to 65%. Common predictors of in-hospital mortality are severity scores, number of failing organs, general condition, respiratory distress and the need for mechanical ventilation or vasopressors. When considering long-term survival after discharge, cancer-related parameters retain their prognostic value.Thoracic surgeons, anesthesiologists, pneumologists, intensivists and oncologists need to develop close and confident partnerships aimed at implementing evidence-based patient care, securing clinical pathways for patient management while promoting education, research and innovation. The final decision on admitting a patient with lung to the ICU should be taken in close partnership between this medical team and the patient and his or her relatives.

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Successful empirical erlotinib treatment of a mechanically ventilated patient newly diagnosed with metastatic lung adenocarcinoma

Cited by 30 publications

References 20 publications

Treatment of Lung Cancer Patients With Actionable Mutations in the Intensive Care Unit

Treatment of Lung Cancer Patients With Actionable Mutations in the Intensive Care Unit

Etiologies of delayed diagnosis and characteristics of patients with newly diagnosed advanced lung cancer initially presented with respiratory failure

Intensive care in thoracic oncology

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