Abstract

Background: In patients with advanced-stage lung cancer and IIP, the clinical questions regarding whether chemotherapy as the initial treatment improves overall survival (OS) and whether it increases the occurrence risk of acute exacerbation of idiopathic interstitial pneumonia (IIP) remain unanswered. Given that chemotherapy-related acute exacerbation of IIP may be a direct cause of mortality in these patients, this study addresses these issues.

Methods: We enrolled 1003 patients from 110 Japanese medical facilities and gathered clinical data from 707 and 296 chemotherapy patients (men: women, 645:62; mean age, 70.4 ± 6.9 years) and BSC (men: women, 261:35; groups' mean ages were 75.2 7.8), respectively. Using patient demographic information (age, sex, smoking status, performance status, history of acute exacerbation of IIP, desaturation on exertion, clinical diagnosis of IIP,high-resolution computed tomography findings, serum fibrotic markers, pulmonary function status, and lung cancer histopathology), we created 222 matched pairs from both groups. To determine whether chemotherapy increased the risk of an acute exacerbation of OS or IIP, respectively, matched data were used to conduct either logistic or Cox regression analyses.

Results: Chemotherapy improved OS in the well-matched cohort (hazard ratio: 0.629, 95 percent confidence interval 0.506–0.783, p < 0.0001); notwithstanding, it included critical intense intensification of IIP (chances proportion: 1.787, 95% CI: 1.026–3.113) when contrasted with BSC.

Conclusions: Chemotherapy has the potential to enhance OS in patients with advanced IIP and lung cancer whencompared to BSC; however, it raises the possibility of an acute IIP exacerbation.