The Efficacy and Safety of First-Line Chemotherapy in Patients With Non-small Cell Lung Cancer and Interstitial Lung Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Lung cancer is a well-known comorbidity of interstitial lung disease (ILD), and the actual efficacy and safety of chemotherapy for patients with non-small cell lung cancer and interstitial lung disease (NSCLC-ILD) have not been determined. We conducted this meta-analysis to assess the efficacy and safety of chemotherapy for patients with NSCLC-ILD. Methods: We searched related studies from the Cochrane Library, PubMed, and Embase. The endpoints were objective response rate (ORR), disease control rate (DCR), 1-year overall survival rate (1-yOS rate), and first-line chemotherapy-related acute exacerbation of interstitial lung disease rate (AE-ILD rate). Results: We included 21 studies involving 684 patients in our analysis. The pooled ORR was 43% (95% CI: 38.0-49.0%), and the pooled DCR was 80.0% (95% CI: 75.7-83.9%). The modified overall 1-yOS rate was 33.0% (95% CI: 29.0-37.0%). The pooled AE-ILD rate was 8.07% (95% CI: 6.12-10.26%). Subgroup analysis revealed a trend for lower AE-ILD rate (4.98%; 95% CI: 2.44-8.37%) in patients with carboplatin plus nab-paclitaxel. Lung function and AE-ILD may be associated with the prognosis of patients with NSCLC-ILD. Conclusions: First-line chemotherapy is effective in patients with NSCLC-ILD, and the AE-ILD rate is acceptable, but the prognosis is limited. Future randomized controlled trials are needed to explore more appropriate treatment regimens to improve the prognosis of patients with NSCLC-ILD.

A phase II feasibility study of carboplatin and nab‐paclitaxel for advanced non‐small cell lung cancer patients with interstitial lung disease (YLOG0114)

“…In a recent meta-analysis, the AE-ILD rate was 8.07%, and in a subgroup analysis of patients treated with carboplatin and nab-paclitaxel, the AE-ILD rate was 4.98%. 22 On including the case that did not meet our criteria for AE-ILD, the rate of AEs was 12%, which was slightly higher than that reported previously. This rate may have been influenced by the small sample size.…”

“…Moreover, the AE‐ILD rate among patients in our study was 4%, similar to that found in two prospective studies. In a recent meta‐analysis, the AE‐ILD rate was 8.07%, and in a subgroup analysis of patients treated with carboplatin and nab‐paclitaxel, the AE‐ILD rate was 4.98% 22 . On including the case that did not meet our criteria for AE‐ILD, the rate of AEs was 12%, which was slightly higher than that reported previously.…”

Proposing synchronous oligometastatic non–small‐cell lung cancer based on progression after first‐line systemic therapy

“…Furthermore, patients with diffuse serosal metastases (pericardial, pleural, meningeal, and mesenteric) were excluded from the present study due to their ineligibility for LAT in accordance with the multidisciplinary consensus statement on the definition of oligometastatic NSCLC 21 . In addition, patients with interstitial lung disease were excluded from this study because they tended to have a poor prognosis due to the limited availability of chemotherapy regimens 24,25 …”

“…21 In addition, patients with interstitial lung disease were excluded from this study because they tended to have a poor prognosis due to the limited availability of chemotherapy regimens. 24,25…”

Anti-Angiogenic Drugs Inhibit Interstitial Lung Disease Progression in Patients With Advanced Non-Small Cell Lung Cancer

“…In contrast, chemotherapy may be a more appropriate treatment option. However, our previous meta-analysis indicated that first-line chemotherapy may be associated with a higher rate of acute exacerbation of interstitial lung disease (AE-ILD), the pooled AE-ILD rate was 8.07% (95% CI: 6.12-10.26%) ( 4 ). Therefore, there is an urgent need for new strategies to treat such patients.…”