The risk of cytotoxic chemotherapy-related exacerbation of interstitial lung disease with lung cancer

J Thorac Oncol. 2011 Jul;6(7):1242-6. doi: 10.1097/JTO.0b013e318216ee6b.


Introduction: It is unknown what type of interstitial lung disease (ILD) has high risk for chemotherapy-related exacerbation of ILD. We investigated the risk of exacerbation of ILD for patients with lung cancer with ILD.

Methods: One hundred nine patients with lung cancer with ILD treated with cytotoxic chemotherapy at Shizuoka Cancer Center between August 2002 and April 2010 were retrospectively reviewed.

Results: On pretreatment computed tomography (CT) of the chest, 69 patients (63%) were identified with usual interstitial pneumonia (UIP) pattern, and 40 patients (37%) had non-UIP pattern. Patients with UIP pattern developed cytotoxic chemotherapy-related exacerbation of ILD more frequently than those with non-UIP pattern (30 versus 8%, p = 0.005). The incidence of grade 5 pulmonary toxicities was 9% in patients with UIP pattern, compared with 3% in those with non-UIP pattern. Multivariate analyses demonstrated that age (<70 years) and CT pattern (UIP) were significant independent risk factors for cytotoxic chemotherapy-related exacerbation of ILD. In small cell lung cancer, overall survival (OS) from the start of first-line chemotherapy was significantly shorter in UIP pattern than non-UIP pattern (median OS: 9 versus 16 months, p = 0.0475), whereas there was no significant difference in patients with non-small cell lung cancer (median OS: 12 versus 9 months, p = 0.2529).

Conclusions: Our results indicated that the incidence of exacerbation of ILD was significantly higher in patients with lung cancer with UIP pattern on CT findings than in those with non-UIP pattern. Therefore, great care is required when administering cytotoxic chemotherapy agents for patients with lung cancer with UIP pattern.

MeSH terms

  • Adenocarcinoma / complications*
  • Adenocarcinoma / drug therapy
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Carcinoma, Squamous Cell / complications*
  • Carcinoma, Squamous Cell / drug therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Diseases, Interstitial / chemically induced*
  • Lung Diseases, Interstitial / diagnostic imaging
  • Lung Neoplasms / complications*
  • Lung Neoplasms / drug therapy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Staging
  • Prognosis
  • Pulmonary Fibrosis / chemically induced
  • Pulmonary Fibrosis / diagnostic imaging
  • Respiratory Mechanics
  • Retrospective Studies
  • Risk Factors
  • Small Cell Lung Carcinoma / complications*
  • Small Cell Lung Carcinoma / drug therapy
  • Tomography, X-Ray Computed