1538P - Acute exacerbation of pre-existing interstitial lung disease (ILD) in patients (pts) with lung cancer under various treatments

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Lung and other Thoracic Tumours
Presenter Hajime Asahina
Authors H. Asahina1, S. Oizumi1, Y. Fujita2, K. Takamura3, T. Kojima4, T. Harada5, Y. Kawai6, H. Dosaka-Akita7, H. Isobe4, M. Nishimura1
  • 1First Department Of Medicine, Hokkaido University School of Medicine, 060-8638 - Sapporo/JP
  • 2Department Of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, Asahikawa/JP
  • 3First Department Of Medicine, Hokkaido P.W.F.A.C Obihiro-Kosei General Hospital, Obihiro/JP
  • 4Department Of Medical Oncology And Respiratory Medicine, KKR Sapporo Medical Center, Sapporo/JP
  • 5Hokkaido Social Insurance Hospital, Sapporo/JP
  • 6Department Of Respiratory Medicine, Oji General Hospital, Tomakomai/JP
  • 7Department Of Medical Oncology, Hokkaido university School of Medicine, Sapporo/JP

Abstract

Background

Acute deterioration of ILD for unknown causes, sometimes called as acute exacerbation (AE), can occur at any point in the course of ILD. However, little is known about its incidence and prognostic significance in lung cancer pts with pre-existing ILD, who receive various treatments; chemotherapy, surgery, palliative radiotherapy, and best supportive care (BSC).

Methods

A total of 242 subjects (6.9% of all) were retrospectively identified to have pre-existing ILD by computed tomography (CT) from a sum of 3524 pts who had been hospitalized for lung cancer treatment at 8 institutions during 2004 to 2009. CT images of all the eligible pts were centrally reviewed. Univariate and multivariate analyses were performed using a Cox proportional hazard model to examine the potential role of any prognostic factors for overall survival (OS) from the initial lung cancer diagnosis.

Results

Pts' characteristics were: male/female = 217/25; median age (range) = 73 (42-98) yrs.; smoking status: ever/never = 223/19; Performance Status: 0/1/2/3/4 = 74/121/23/19/5; Stage I/II/III/IV = 48/10/98/86; Histology: adeno/squamous/large/NOS/small = 90/75/6/19/52; CT pattern: usual interstitial pneumonia (UIP)/non-UIP = 118/124; extent of normal lung on baseline CT: 10-50%/60-90% = 154/88; pre-existing emphysema: yes/no = 178/64. AE occurred in 71 of 242 pts (29%) overall; 56 of 147 pts (38%) with chemotherapy, 6 of 38 pts (16%) with surgery, 2 of 17 pts (12%) with palliative radiotherapy, and 5 of 36 pts (14%) with BSC alone, and chemotherapy was an independent risk factor for the occurrence of AE (P < 0.001). When separated by histology, in NSCLC, multivariate analysis revealed that age (≥70 yrs., hazard ratio [HR]: 1.84, 95%CI: 1.25-2.71, p = 0.002), PS (≥2, HR: 2.90, 95%CI: 1.80-4.68, p < 0.001), stage (≥3, HR: 4.03, 95%CI: 2.42-6.71, p < 0.001), and AE (HR: 1.84, 95%CI: 1.26-2.69, p = 0.002) were significantly associated with OS, while in SCLC, AE was the only significant prognostic factor (HR: 2.26, 95%CI: 1.08-4.73, p = 0.032).

Conclusions

The occurrence of AE is not rare in the lung cancer treatment, particularly during chemotherapy, and it is a factor for poor prognosis in pts with pre-existing ILD.

Disclosure

All authors have declared no conflicts of interest.