The Efficacy and Safety of Chemotherapy in Patients With Nonsmall Cell Lung Cancer and Interstitial Lung Disease

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Chemotherapy plays a critical and venturous role against the co-morbidity of nonsmall cell lung cancer and interstitial lung disease (NSCLC–ILD). We performed a Bayesian meta-analysis and systematic review to evaluate the safety and efficacy of the chemotherapy in NSCLC–ILD patients. EMBASE, PubMed, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov (up to January 2015). We included all study designs except case reports, all studies with NSCLC–ILD patients and all the possible chemotherapy regimens. Quality was assessed by a components approach. We derived summary estimates using Bayesian method through WinBUGS (version 1.4.3, MRC Biostatistics Unit, Cambridge, UK). Seven studies involving 251 patients with NSCLC–ILD were included in the meta-analysis. The treatment response (complete remission, 0; [partial remission, 39.1%; 95% credible interval [CrI], 32.6–45.7]; [stable disease, 36%; 95% CrI, 29.6–42.2]; [PD, 15.4%; 95% CrI, 11.3–19.8]; [nonevaluable, 6.4%; 95% CrI, 2.7–10.1]; [overall response rate, 41.3%; 95% CrI, 35.3–47.4]; [disease control rate, 77.7%; 95% CrI, 72.2–82.7]) were comparable to that of patients with NSCLC alone; the survival outcomes (median overall survival, median progression-free survival, and 1-year survival rate) were slightly worse, especially the lower 1-year survival rate. Platinum-based doublets as first-line chemotherapy may be related to higher incidence of acute exacerbation-ILD in first line chemotherapy (AE, 8.47%; 95% CrI, 5.04–12.6). The data selection bias and small patient number make the meta-analysis of treatment response and conclusions generated from these data inaccurate. The present meta-analysis suggests that chemotherapy might be an effective therapy for patients with NSCLC–ILD, but it might be associated with higher incidence of acute exacerbation.