Feasibility of the administration of chemotherapy using cisplatin plus etoposide for non-small cell lung cancer patients with interstitial lung disease on chest computed tomography

Background Chemotherapy for non-small cell lung cancer (NSCLC) patients with interstitial lung disease (ILD) has been challenging due to the possibility of the acute exacerbation of ILD as a life-threatening adverse effect. No acceptable regimen for such patients has been established. Therefore, we herein assessed our series of NSCLC patients with ILD who were treated with cisplatin plus etoposide (PE). Patients and methods The unresectable NSCLC patients with ILD detected on chest computed tomography (CT) who received PE at our department between December 2006 and December 2013 were retrospectively reviewed. Cisplatin (80 mg/m², day 1) and etoposide (100 mg/m², days 1 to 3) were administered every three weeks. Results Thirty-two consecutive NSCLC patients with ILD were evaluated. Twenty-four received PE as first-line treatment, while the other eight received it as second-line or later treatment. Twenty-three patients exhibited the usual pneumonitis (UIP) pattern, eight possible UIP pattern and one was inconsistent to UIP on CT. Grade 3/4 hematological toxicities were frequently seen, including neutropenia in 23 (74.2%). Febrile neutropenia was seen in six (19.4%) patients. Two patients experienced grade 2 pneumonitis after PE, but successfully recovered. The overall response rate was 31.2%. The median progression-free survival was 3.4 months and the median overall survival for all patients was 8.5 months. Conclusion PE treatment for unresectable NSCLC patients with ILD in our series was considered to be relatively safe, with an acceptable tumor response and survival. Obviously, careful patient selection and management are warranted. A prospective evaluation should also be performed.