Real-world evaluation of carboplatin plus a weekly dose of nab-paclitaxel for patients with advanced non-small-cell lung cancer with interstitial lung disease

Our plain-English summary of Real-world evaluation of carboplatin plus a weekly dose of nab-paclitaxel for patients with advanced non-small-cell lung cancer with interstitial lung disease, by S. Igawa, N. Nishinarita, A. Takakura, et al (Cancer Management and Research, 2018).

The study

• Authors: S. Igawa, N. Nishinarita, A. Takakura, T. Ozawa, S. Harada, S. Kusuhara, H. Niwa, S. Hosotani, H. Sone, Y. Nakahara, T. Fukui, H. Mitsufuji, M. Yokoba, M. Kubota, M. Katagiri, J. Sasaki, K. Naoki
• Journal: Cancer Management and Research
• Published: 2018;10:7013-7019
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The optimal chemotherapy regimen for non-small-cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) remains unknown. Therefore, in this study, we investigated the real-world efficacy and safety of carboplatin (CBDCA) plus nab-paclitaxel (nab-PTX) as a first-line regimen for NSCLC patients with ILD.

Patients And Methods: We retrospectively reviewed advanced NSCLC patients with ILD who had received CBDCA plus nab-PTX as a first-line chemotherapy regimen between April 2013 and March 2018. Patients were diagnosed with ILD based on the findings of a pretreatment high-resolution computed tomography of the chest.

Results: The 34 patients enrolled in this study were included in the efficacy and safety analysis. Collagen vascular disease or a history of exposure to dust or asbestos was not reported for any patients. The median age of patients was 71 years (range, 59-83 years), and 32 patients had a performance status of 0 or 1. The overall response rate was 38.2%. The median progression-free survival and overall survival were 5.8 months and 12.7 months, respectively. Chemotherapy-related acute exacerbation of ILD was observed in two patients (5.7%). Other toxicities were feasible, and no treatment-related deaths occurred.

Conclusion: CBDCA plus nab-PTX, as a first-line chemotherapy regimen for NSCLC, showed favorable efficacy and safety in patients with preexisting ILD.

In plain English

This study was about lung cancer treatment, not asbestos. The authors reviewed records of 34 Kitasato University Hospital patients in Japan with advanced non-small-cell lung cancer and CT-diagnosed interstitial lung disease. Finding no collagen vascular disease or dust or asbestos exposure, the authors classified the lung disease in all of them as idiopathic interstitial pneumonia. All received carboplatin with weekly nab-paclitaxel as first-line chemotherapy between April 2013 and March 2018. Thirteen had partial tumor shrinkage, a response rate of 38.2% (95% CI 22% to 55%). Median progression-free survival (time until cancer worsened or death) was 5.8 months (95% CI 2.2 to 8.9), and median overall survival was 12.7 months (95% CI 8.9 to 14.2). Two patients had a grade 2 lung disease flare-up linked to this chemotherapy, and no treatment-related deaths occurred. Table 3 lists 13 patients with severe neutropenia (low neutrophils, a type of white blood cell). The article reports this as 43.3%, a figure that does not match its 34 patients. The authors concluded the combination showed favorable efficacy and safety. They said the results were not definitive given the small, single-center, retrospective design.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective, single-center cohort study (review of patient records)
• Who was studied: 34 patients with advanced non-small-cell lung cancer and interstitial lung disease who received first-line carboplatin plus nab-paclitaxel at Kitasato University Hospital, Japan, between April 2013 and March 2018. Median age was 71 years (range 59 to 83), and there were 29 men and 5 women. Because no patient had collagen vascular disease or dust or asbestos exposure, the lung disease was diagnosed in all of them as idiopathic interstitial pneumonia.
• Exposure: The study examined a chemotherapy regimen, not asbestos: nab-paclitaxel 100 mg/m2 on days 1, 8 and 15, with carboplatin every 4 weeks. The authors reported that no patient had collagen vascular disease or a history of exposure to dust or asbestos.
• Main results:
  • Among the 34 patients, 13 had a partial response, 12 had stable disease and 8 had progressive disease. One patient could not be evaluated.
  • The overall response rate for all 34 patients was 38.2% (95% CI 22% to 55%; Table 2 gives 21.9 to 54.5).
  • For all patients, median progression-free survival (from the start of chemotherapy until disease progression or death) was 5.8 months (95% CI 2.2 to 8.9). Median overall survival was 12.7 months (95% CI 8.9 to 14.2).
  • A grade 2 acute exacerbation of interstitial lung disease related to first-line chemotherapy occurred in two patients. No treatment-related deaths occurred.
  • For grade 3 or higher toxicity, Table 3 lists 6 grade 3 and 7 grade 4 cases of neutropenia (low neutrophils) and 9 grade 3 and 2 grade 4 cases of leukopenia (low white blood cells overall). The article reports these as 43.3% and 36.7% of patients. Those percentages do not match the 34-patient total, and the article does not explain the denominator.
  • Febrile neutropenia occurred in six patients, reported as 20%.
  • Among the 17 patients who went on to second-line chemotherapy, acute exacerbation of interstitial lung disease occurred in two (11.7%).
• The authors' conclusion: The authors concluded that carboplatin plus nab-paclitaxel showed favorable efficacy and safety as first-line chemotherapy for non-small-cell lung cancer patients with preexisting interstitial lung disease. They said a large prospective study is needed to confirm this.
• Limitations the authors state:
  • The results cannot be considered definitive because the study was retrospective, single-center and relatively small.
  • Interstitial lung disease was diagnosed from CT findings rather than by tissue (histological) diagnosis.
  • Flare-ups (exacerbations) of interstitial lung disease were also diagnosed from CT findings and could not be confirmed by tissue analysis.

Topics

Medical terms in this study, explained in our Lexicon: Carboplatin, Lung Cancer, Interstitial Lung Disease, Chemotherapy, Collagen, Performance Status, Progression-Free Survival, Overall Survival.

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