Clinical experiences of cytotoxic chemotherapy in patients with lung cancer complicated by interstitial pneumonia who were treated with pirfenidone...

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Cancer Treatment in Patients with Comorbidities
Thoracic Malignancies
Presenter Yukihiro Yano
Citation Annals of Oncology (2018) 29 (suppl_9): ix150-ix169. 10.1093/annonc/mdy425
Authors Y. Yano, K. Nishida, M. Ishijima, T. Uenami, Y. Akazawa, T. Yamaguchi, M. Mori
  • Thoracic Oncology, Toneyama National Hospital, 560-8552 - Toyonaka/JP

Abstract

Background

Interstitial pneumonia (IP) is considered to be risk factor for patients with lung cancer (LC). Cytotoxic chemotherapy (CC) may trigger acute exacerbation (AE) of IP. Ideal treatment strategies for LC patients with IP are not well established. Pirfenidone is anti-fibrotic drug and approved for treatment to idiopathic pulmonary fibrosis (IPF) in several countries including Japan. Deterioration of vital capacity is prevented with pirfenidone. We considered pirfenidone may prevent occurrence of AE during treatment with CC to LC patients with IP.

Methods

We retrospectively analyzed patients with advanced LC with IP who were treated with pirfenidone and CC simultaneously.

Results

We experienced 13 patients. The median patient age was 68. Histological type was adenocarcinoma followed by squamous cell carcinoma, non-small cell carcinoma, and small cell carcinoma in 5, 3, 3, and 2 patients, respectively. Clinical diagnoses were made as IPF, collagen vascular disease related IP, and respiratory bronchiolitis-associated interstitial lung disease in 10, 2 and 1 patients, respectively. Mild fibrosis was diagnosed clinically in 9 patients and moderate in 4 patients. Treatment was delivered with carboplatin plus nab-paclitaxel, S-1, and etoposide in 8, 3, and 2 patients, respectively. Pirfenidone was administered prior to CC in 12 patients. Initial dose of pirfenidone was 600mg daily and increased to 1200mg daily after 1-5 weeks from the initiation. No patients with first line CC experienced AE. Slight ground glass shadow was observed in one patient during second line S-1 monotherapy and improved with steroid therapy. AE was observed in 3 patients as lung cancer itself progressed. Twelve patients were administered pirfenidone 1200mg daily without dose reduction and one patient experienced dose reduction due to appetite loss.

Conclusions

We could accomplish CC with simultaneous pirfenidone administration to 13 LC patients with IP. No patients experienced severe adverse effect. We consider simultaneous administration of CC and pirfenidone may prevent AE in LC patients with IP.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Toneyama National Hospital.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.