S-1 Plus Carboplatin May Be Effective in NSCLC Patients With Interstitial Lung Disease

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Patients with severe complications, such as interstitial lung disease, are often excluded from clinical studies assessing chemotherapy in NSCLC.
Patients with severe complications, such as interstitial lung disease, are often excluded from clinical studies assessing chemotherapy in NSCLC.

S-1 plus carboplatin may potentially be a novel and effective chemotherapeutic treatment option among patients with non-small cell lung cancer (NSCLC) with interstitial lung disease (ILD), according to a study published in Lung Cancer.1

Lung cancer and its treatment modalities have been extensively studied, but patients with severe complications, such as ILD, are often excluded from clinical studies assessing chemotherapy in NSCLC. Previous studies have suggested that S-1 and carboplatin may be effective for this treatment population, but data has been retrospective in nature; evidence from prospective investigations is needed.

For this phase 2 study, researchers enrolled 33 patients with advanced or recurrent NSCLC with ILD who had never received chemotherapy or postoperative chemotherapy. Patients received oral S-1 40 to 60 mg/m2 twice daily (according to patient body surface area) for 14 days plus carboplatin AUC 5 intravenously on day 1 of each cycle; the treatment regimen was repeated every 4 weeks for a maximum of 6 cycles.

The median age of participants was 70 years; 48.5% (16) had squamous cell carcinoma histology, and 66.7% of patients had ILD with the usual interstitial pneumonia pattern. Patients received a median of 3 cycles, and 63.6% of patients received at least 3 cycles.

After a median follow-up of 10.3 months, the overall response rate was 33.3% and the disease control rate was 78.8%. The median progression-free survival was 4.8 months (95% CI, 2.6-5.6), the median survival time was 12.8 months (95% CI, 7.6-22.7), and the 1-year survival rate was 51.4% (95% CI, 32.0-70.8).

The most frequently reported grade 3 or higher adverse events (AE) were neutropenia and thrombocytopenia, but no instances of febrile neutropenia were observed. Other AEs included appetite loss, nausea, and fever.

The authors concluded that “S-1 plus [carboplatin] may be a treatment option for these patients. However, considering the inferior [overall survival] compared with NSCLC without ILD, salvage therapy in this group of patients should be selected with caution. Further large-scale prospective studies will be needed in the future in order to identify more effective and safer therapies for advanced NSCLC with ILD.”

Reference

  1. Hanibuchi M, Kakiuchi S, Atagi S, et al. A multicenter, open-label, phase II trial of S-1 plus carboplatin in advanced non-small cell lung cancer patients with interstitial lung disease [published online September 12, 2018]. Lung Cancer. doi: 10.1016/j.lungcan.2018.09.007

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