Exacerbation of idiopathic interstitial pneumonias associated with lung cancer therapy.
OBJECTIVE
Idiopathic interstitial pneumonias (IIPs) frequently occur in association with lung cancer. However, there is no consensus on the best treatment of acute exacerbation of IIP in lung cancer patients (LC with IIP), including those with iatrogenic acute lung injury resulting from cancer treatments. We aimed to identify an appropriate strategy for treatment of this condition. We analyzed clinical features of 120 LC with IIP, retrospectively.


RESULTS
The incidence of acute exacerbation related to anticancer treatment was 22.7%; when the incidence was examined separately for patients receiving chemotherapy or the best supportive care, the incidence was 20.0% and 31.3%, respectively. Additional investigations should be directed to finding suitable regimens for treatment of LC with IIP and the selection of appropriate patients with LC with IIP for chemotherapy. The incidence of acute exacerbation caused by combination regimens of carboplatin + paclitaxel or a platinum agent + etoposide was significantly lower than that of other regimens (0% vs. 18%, respectively; p=0.025, Fisher's Exact Test). Patients with high levels of C-reactive protein before chemotherapy had a significantly higher risk of developing acute exacerbation (odds ratio 5.60, p=0.028).


CONCLUSIONS
There was no evidence that anticancer treatment, including chemotherapy, should be avoided in LC with IIP. To establish an appropriate cancer treatment for LC with IIP, a prospective clinical study should be performed to evaluate various treatment modalities in a larger patient population.
Department of Internal Medicine, Nippon Medical School, Tokyo.
Yuji
Y
Minegishi
Kiyoshi
K
Takenaka
Hideki
H
Mizutani
Junko
J
Sudoh
Rintaro
R
Noro
Tetsuya
T
Okano
Arata
A
Azuma
Akinobu
A
Yoshimura
Masahiro
M
Ando
Eitaka
E
Tsuboi
Shoji
S
Kudoh
Akihiko
A
Gemma
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
D000970:Antineoplastic Agents