Kashiwada Takeru, Saito Yoshinobu, Terasaki Yasuhiro, Hisakane Kakeru, Takeuchi Susumu, Sugano Teppei, Miyanaga Akihiko, Noro Rintaro, Minegishi Yuji, Seike Masahiro, Kubota Kaoru, Gemma Akihiko
Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Jpn J Clin Oncol. 2019 Feb 1;49(2):165-173. doi: 10.1093/jjco/hyy180.
Nanoparticle albumin-bound paclitaxel is indicated for the treatment of patients with lung cancer. It can induce interstitial lung disease, but the incidence of nanoparticle albumin-bound paclitaxel-associated interstitial lung disease in clinical practice has not been determined. We investigated the incidence of interstitial lung disease in patients with lung cancer who had received nanoparticle albumin-bound paclitaxel therapy at our institution.
We reviewed clinical data for patients with advanced lung cancer who received nanoparticle albumin-bound paclitaxel with or without carboplatin or bevacizumab therapy at the Nippon Medical School Main Hospital between April 2013 and September 2017. Interstitial lung disease was diagnosed based on clinical symptoms, radiographic findings and exclusion of other diseases.
A total of 110 advanced lung cancer patients received nanoparticle albumin-bound paclitaxel, and nine of them (8.2%) developed interstitial lung disease. Of those who developed interstitial lung disease, eight were treated with corticosteroids and three received cyclophosphamide pulse therapy. High-resolution computed tomography images demonstrated diffuse alveolar damage pattern pneumonitis in seven patients and organized pneumonia pattern pneumonitis in two patients. Six of the patients with diffuse alveolar damage pattern pneumonitis died from respiratory failure. The two patients with organized pneumonia pattern pneumonitis recovered. The incidence of interstitial lung disease was 19.0% (8/42) among patients with preexisting interstitial pneumonia and 1.5% (1/68) among those without preexisting interstitial pneumonia. Six patients with preexisting interstitial pneumonia met the criteria for acute exacerbation of interstitial pneumonia (14.3%).
Nanoparticle albumin-bound paclitaxel-associated interstitial lung disease was a severe and potentially fatal adverse event. We found it demonstrated diffuse alveolar damage or organized pneumonia pattern pneumonitis, and preexisting interstitial pneumonia was associated with higher rate of nanoparticle albumin-bound paclitaxel-associated interstitial lung disease.
纳米白蛋白结合型紫杉醇被用于治疗肺癌患者。它可诱发间质性肺疾病，但纳米白蛋白结合型紫杉醇相关间质性肺疾病在临床实践中的发生率尚未确定。我们调查了在我院接受纳米白蛋白结合型紫杉醇治疗的肺癌患者中间质性肺疾病的发生率。
我们回顾了2013年4月至2017年9月期间在日本医科大学附属医院接受纳米白蛋白结合型紫杉醇联合或不联合卡铂或贝伐单抗治疗的晚期肺癌患者的临床资料。间质性肺疾病根据临床症状、影像学表现及排除其他疾病来诊断。
共有110例晚期肺癌患者接受了纳米白蛋白结合型紫杉醇治疗，其中9例（8.2%）发生了间质性肺疾病。在发生间质性肺疾病的患者中，8例接受了皮质类固醇治疗，3例接受了环磷酰胺冲击治疗。高分辨率计算机断层扫描图像显示，7例患者为弥漫性肺泡损伤型肺炎，2例患者为机化性肺炎型肺炎。6例弥漫性肺泡损伤型肺炎患者死于呼吸衰竭。2例机化性肺炎型肺炎患者康复。既往有间质性肺炎的患者中间质性肺疾病的发生率为19.0%（8/42），无既往间质性肺炎的患者中发生率为1.5%（1/68）。6例既往有间质性肺炎的患者符合间质性肺炎急性加重的标准（14.3%）。
纳米白蛋白结合型紫杉醇相关间质性肺疾病是一种严重且可能致命的不良事件。我们发现它表现为弥漫性肺泡损伤或机化性肺炎型肺炎，既往有间质性肺炎与纳米白蛋白结合型紫杉醇相关间质性肺疾病的较高发生率相关。
