Yuichi Ozawa1, Daisuke Akahori2, Keigo Koda2, Takefumi Abe2, Hirotsugu Hasegawa2, Takashi Matsui2, Masayuki Tanahashi3, Hiroshi Niwa3, Kazunari Yamada4, Koshi Yokomura2, Takafumi Suda5. 1. Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8105, Japan. u1.ozawa@sis.seirei.or.jp. 2. Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8105, Japan. 3. Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8105, Japan. 4. Department of Radiation Oncology, Seirei Mikatahara General Hospital, 3453, Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8105, Japan. 5. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Abstract
PURPOSE: Pre-existing interstitial lung disease (pre-ILD) increases the risk of chemotherapy-related lung injury (CRLI). However, whether the risk varies by type of anti-cancer cytotoxic agent in patients with pre-ILD is unknown. In this study, we hypothesized that S-1, an oral fluoropyrimidine agent, is associated with a smaller CRLI risk than docetaxel (DTX) and investigated these agents together with radiological evaluations of pre-ILD via pre-treatment chest computed tomography (CT). METHODS: After reviewing 234 and 352 patients who underwent evaluable chest CT within 6 months prior to the administration of S-1 or DTX, respectively, from January 2006 to October 2014, 60 and 89, respectively, of these patients with pre-ILD were retrospectively analysed. RESULTS: In total, 2 persons administered S-1 (3 %) and 16 treated with DTX (18 %) developed CRLI (p = 0.007) after the initial treatment (mean, 61 days), of whom 1 and 7, respectively, died because of respiratory failure. Pre-treatment CT revealed that 9 S-1-treated patients (16 %) and 15 DTX-treated patients (17 %) had pre-ILD occupying more than 25 % of the lung field. Multivariate analysis demonstrated that DTX administration increased the risk of CRLI by 6.47-fold versus S-1 therapy (p = 0.016). Of note, the area occupied by pre-ILD was also associated with the risk of CRLI (<25 %; odds ratio 0.309, p = 0.045). CONCLUSIONS: Our results indicated that S-1 is associated with a smaller risk of CRLI than DTX. The area occupied by pre-ILD should also be noted when administrating anti-cancer agents.
PURPOSE: Pre-existing interstitial lung disease (pre-ILD) increases the risk of chemotherapy-related lung injury (CRLI). However, whether the risk varies by type of anti-cancer cytotoxic agent in patients with pre-ILD is unknown. In this study, we hypothesized that S-1, an oral fluoropyrimidine agent, is associated with a smaller CRLI risk than docetaxel (DTX) and investigated these agents together with radiological evaluations of pre-ILD via pre-treatment chest computed tomography (CT). METHODS: After reviewing 234 and 352 patients who underwent evaluable chest CT within 6 months prior to the administration of S-1 or DTX, respectively, from January 2006 to October 2014, 60 and 89, respectively, of these patients with pre-ILD were retrospectively analysed. RESULTS: In total, 2 persons administered S-1 (3 %) and 16 treated with DTX (18 %) developed CRLI (p = 0.007) after the initial treatment (mean, 61 days), of whom 1 and 7, respectively, died because of respiratory failure. Pre-treatment CT revealed that 9 S-1-treated patients (16 %) and 15 DTX-treated patients (17 %) had pre-ILD occupying more than 25 % of the lung field. Multivariate analysis demonstrated that DTX administration increased the risk of CRLI by 6.47-fold versus S-1 therapy (p = 0.016). Of note, the area occupied by pre-ILD was also associated with the risk of CRLI (<25 %; odds ratio 0.309, p = 0.045). CONCLUSIONS: Our results indicated that S-1 is associated with a smaller risk of CRLI than DTX. The area occupied by pre-ILD should also be noted when administrating anti-cancer agents.
Authors: Stacey-Ann Whittaker Brown; Maria Padilla; Grace Mhango; Emanuela Taioli; Charles Powell; Juan Wisnivesky Journal: Ann Am Thorac Soc Date: 2019-08