Chae Uk Chung

Lesser Toxicities of Belotecan in Patients with Small Cell Lung Cancer: A Retrospective Single-Center Study of Camptothecin Analogs

Purpose. Topotecan and belotecan are camptothecin derivatives that are used to treat small cell lung cancer (SCLC). This study compared the toxicities and efficacies of belotecan and topotecan monotherapies in patients with SCLC. Methods. We retrospectively reviewed data from 94 patients with SCLC (with or without prior chemotherapy) who were treated using belotecan monotherapy (n = 59, 188 cycles) or topotecan monotherapy (n = 35, 65 cycles) between September 2003 and December 2011. Results. Thrombocytopenia occurred during 42% and 61.5% of the belotecan and topotecan cycles, respectively (p = 0.007). Significant differences between belotecan and topotecan were also observed for grade 4/5 lung infection (3.2% versus 10.8%, resp.; p = 0.003), all-grade headache (3.2% versus 10.8%, resp.; p = 0.017), and grade 4/5 increased liver enzymes (0.5% versus 4.6%, resp.; p = 0.023). The median TTPDs, CSSs, and OSs were 14 months and 11.6 months (p = 0.646), 10 months and 7 months (p = 0.179), and 34.5 months and 21.4 months (p = 0.914) after belotecan and topotecan monotherapy, respectively. Conclusions. Belotecan monotherapy may be safer than topotecan monotherapy in SCLC patients. And in terms of efficacy, belotecan could be comparable to topotecan monotherapy.

Isoniazid and Pulmonary Fibrosis

To the Editor: The anti-tuberculosis (TB) therapy can cause various drug adverse effects including hepatotoxicity, nephrotoxicity and skin rash.[1,2] There are some case reports about interstitial lung disease (ILD) such as pneumonitis caused by isoniazid (INH), rifampin (RFP), ethambutol (EMB).[3,4] The causative drug was discontinued permanently or re-administrated after desensitization therapy. But the pulmonary fibrosis induced by short anti-TB medication was very rare. We herein report a case of pulmonary fibrosis due probably to INH, which was developed after 3 weeks of anti-TB treatment. A 42-year-old man was admitted to hospital due to continuous fever, night sweating, and weight loss for 1-month and exacerbated dyspnea on exercise (DOE) for 2 weeks. Chest posterioranterior showed right side pleural effusion [Figure ​[Figure1a1a and ​andb].b]. Although pleural biopsy showed chronic inflammation, the effusion was exudates dominantly with lymphocyte cells and adenosine deaminase was 136.2 IU/L, highly suggesting TB pleurisy. Overall, he was diagnosed as TB pleurisy. INH, RFP, EMB, and pyrazinamide were administered, and the pleural effusion was drained with chest catheter. After taking anti-TB medication, symptoms diminished gradually but intermittent fever above 38°C occurred. After 3 weeks of anti-TB medication, he complained of DOE and cough again, and the symptoms got worsened. The arterial gas blood analysis gave PaO2 41 mmHg, PaCO2 49 mmHg, and SaO2 86% on room air. Chest images showed no increase of pleural effusion but newly developed bilateral lung infiltrations including glass ground opacity, consolidation, and the reticular opacity [Figure ​[Figure1c1c and ​and1d].1d]. Because ILD induced by anti-TB medication was mostly suspected, all drugs were discontinued. To define the diagnosis of lung lesion, open lung biopsy was promptly performed. Biopsy at right lower lobe revealed chronic interstitial inflammation with fibrosis [Figure 1e]. We considered provocation test confirming the causative drug, but we thought that drug challenge could aggravate the lung injury. Many references suggested that INH is most common cause of pneumonitis.[2,4,5] At postoperation days 5, anti-TB medication except INH was started with prednisolone 60 mg and tapered. At 2 months after open lung biopsy, follow-up chest images showed combined pulmonary fibrosis and emphysema [Figure 1f]. Figure 1 (a) Before initiation of anti-tuberculosis (TB) medication, chest posterioranterior (PA) showed right side pleural effusion; (b) Chest computed tomography (CT) scan before anti-TB medication; (c) After 3 weeks of anti-TB therapy, chest PA exhibited newly ... The frequency of ILD caused by anti-TB medication is relatively rare, about 2%. The most frequently causative drug is INH and other drugs such as RFP and EMB also cause ILD.[4] But there is no case report of the patient with INH-induced lung fibrosis. Pneumonitis induced by anti-TB medication causes some symptoms including fever, dyspnea, rash, and even chest pain. Among them, fever is the most common symptom.[4,5] In this case, the patients complained of intermittent fever above 38°C within first 10 days of TB treatment, the fever might be an early sign of pneumonitis. In this case, the lung fibrosis was developed very rapidly in 3 weeks of anti-TB medication, and the causative drug is probably INH. This case emphases that the clinician should consider the possibility of drug-induced pneumonitis or lung fibrosis even at initial phase of anti-TB treatment when the patient shows fever and complains of worsening of DOE.

CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy

Background We developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system. Methods We retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016. Results There were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively. Conclusion The additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.

The Prognostic Value of the Tumor Shrinkage Rate for Progression-Free Survival in Patients with Non-Small Cell Lung Cancer Receiving Gefitinib

Background The efficacy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy can be measured based on the rate of treatment response, based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria or progression-free survival (PFS). However, there are some patients harboring sensitive EGFR mutations who responded poorly to EGFR-TKI therapy. In addition, there is variability in the PFS after EGFR-TKI treatment. Methods We performed a retrospective analysis of the medical records of 85 patients with non-small cell lung cancer, who had achieved a stable disease or better response at the first evaluation of treatment response, after receiving a 2-month course of gefitinib. We calculated the tumor shrinkage rate (TSR) by measuring the longest and perpendicular diameter of the main mass on computed tomography before, and 2 months after, gefitinib therapy. Results There was a significant positive correlation between the TSR and PFS (R=0.373, p=0.010). In addition, a simple linear regression analysis showed that the TSR might be an indicator for the PFS (B±standard error, 244.54±66.79; p=0.001). On univariate analysis, the sex, histologic type, smoking history and the number of prior chemotherapy regimens, were significant prognostic factors. On multivariate regression analysis, both the TSR (β=0.257, p=0.029) and adenocarcinoma (β=0.323, p=0.005) were independent prognostic factors for PFS. Conclusion Our results showed that the TSR might be an early prognostic indicator for PFS in patients receiving EGFR-TKI therapy.