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Y. Ichinose

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    P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P1.01-049 - Feasibility of Cisplatin plus Etoposide for Non-Small Cell Lung Cancer Associated with Interstitial Lung Disease on Chest Computed Tomography (ID 541)

      09:30 - 17:00  |  Author(s): Y. Ichinose

      • Abstract

      Despite the recent remarkable progress in chemotherapy (CTx) regimens, the application of CTx for non-small cell lung cancer (NSCLC) associated with interstitial lung disease (ILD) remains challenging because of the possibility of acute deterioration of the underlying ILD, which can lead to severe respiratory insufficiency, thus decreasing the life expectancy of the patient. To date, no acceptable CTx regimen for patients with ILD has been established. We herein assessed our series of non-small cell lung cancer patients with ILD treated with cisplatin and etoposide (PE).

      Unresectable NSCLC patients with ILD detected on chest computed tomography (CT) who received PE at our department between December 2006 and December 2013 were retrospectively reviewed. ILD was defined as interstitial opacity on CT, as confirmed by an independent radiologist. Overall survival (OS) was defined as the time from the start date of any treatment to the date of death from any cause. Progression-free survival (PFS) was defined as the time from the start date of PE to disease progression or cancer-related death.

      A total of 32 NSCLC patients with ILD were evaluated. There were 31 males and one female, with a median age of 66 (53-79) years. The ECOG performance status was 0/1/2 in 17/13/2 patients. Seventeen patients had adenocarcinoma, six patients had squamous cell carcinoma and nine patients had NSCLC. Three patients experienced post-surgical recurrence. The clinical stage was IIB/IIIA/IIIB//IV in 2/5/8/17 patients. The subtypes of ILD classified according to the CT appearance were the usual interstitial pneumonia pattern in 22 patients and a non-specific interstitial pneumonia pattern and previous drug-induced pneumonia in five patients each. Oral steroids were administered concomitant with CTx in two patients. Twenty-four patients received PE as the first-line CTx, while the other eight patients received PE after more than two regimens of CTx. Grade 3/4 hematological toxicity of leukopenia was noted in 15 (46.9%) patients, neutropenia was observed in 24 (75.0%) patients, thrombocytopenia occurred in four (12.5%) patients and anemia was detected in six (18.8%) patients. Grade 3 febrile neutropenia was recorded in six (19.4%) patients, grade 3 and 4 acute myocardial infarction occurred in one patient each and grade 3 cerebral infarction occurred in one patient. Two patients experienced grade 2 worsening of ILD and successfully recovered. The response rate was PR/SD/PD in 10/19/2 patients, and one patient could not be evaluated because of an adverse event. The median PFS was 3.9 months, the one-year PFS was 12.8% and the two-year PFS was 4.3%. Additionally, the median OS for all patients was 11.2 months, the one-year OS was 46.2% and the two-year OS was 14.2%.

      PE treatment for unresectable NSCLC associated with ILD was demonstrated to be relatively safe in our series, with an acceptable tumor response and OS. However, careful patient selection and management during CTx are required. The limitation of the current analysis is its retrospective nature and the fact that there was a single arm of CTx therapy. Hence, future prospective comparisons of other CTx regimens are warranted.