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Original Research: LUNG CANCER |

Impact of Preoperative Chemotherapy on Pulmonary Function Tests in Resectable Early-Stage Non-small Cell Lung Cancer

M. Patricia Rivera, MD, FCCP; Frank C. Detterbeck, MD, FCCP; Mark A. Socinski, MD, FCCP; Dominic T. Moore, PhD; Martin J. Edelman, MD; Thierry M. Jahan, MD; Rafat H. Ansari, MD; James D. Luketich, MD, FCCP; Guangbin Peng, MS; Matthew Monberg, MS; Coleman K. Obasaju, MD, PhD; Richard J. Gralla, MD
Author and Funding Information

*From the Multidisciplinary Thoracic Oncology Group (Drs. Rivera, Socinski, and Moore), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Yale Comprehensive Cancer Center (Dr. Detterbeck), Yale University, New Haven, CT; University of Maryland Greenebaum Cancer Center (Dr. Edelman), Baltimore, MD; University of California San Francisco (Dr. Jahan), San Francisco, CA; Michiana Hematology/Oncology (Dr. Ansari), South Bend, IN; University of Pittsburgh Physicians (Dr. Luketich), Pittsburgh, PA; Eli Lilly and Company (Mr. Peng, Mr. Monberg, and Dr. Obasaju) Indianapolis, IN; and North Shore-Long Island Jewish Health System (Dr. Gralla), Lake Success, NY.

Correspondence to: M. Patricia Rivera, MD, University of North Carolina Pulmonary and Critical Care Medicine, 4133 Bioinformatics, Chapel Hill, NC 27599-7248; e-mail: mprivera@med.unc.edu


This study was sponsored by Eli Lilly and Company. Preliminary results were previously presented at the 2005 American Society for Clinical Oncology meeting.

Drs. Rivera, Detterbeck, Socinski, Moore, and Ansari have no conflicts of interest to disclose. Dr. Edelman has received consulting fees, research funds, and honoraria from Eli Lilly and Bristol-Myers Squibb. Dr. Jahan discloses consulting with Poniard and stock ownership with Biogen and Hana. Dr. Luketich has received research grants, stock, consulting fees, and honoraria from various companies. Mr. Peng discloses employment and stock ownership with Eli Lilly. Drs. Monberg and Obasaju disclose employment and stock ownership with Eli Lilly. Dr. Gralla discloses prior consulting with Eli Lilly.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1588-1595. doi:10.1378/chest.08-1430
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Background:  Several chemotherapy agents, including gemcitabine and paclitaxel, have been reported to cause interstitial pneumonitis. The incidence of pulmonary toxicity from the combination of gemcitabine and paclitaxel is reported to be approximately 5%. In this report, pulmonary function test (PFT) results were analyzed from two similar randomized phase 2 trials that tested platinum and nonplatinum regimens preoperatively in patients with stage I or II non-small cell lung cancer (NSCLC).

Methods:  The regimens included gemcitabine plus carboplatin, paclitaxel, or cisplatin. PFT and dyspnea scores were obtained at baseline and postchemotherapy, and were compared to one of several secondary end points, including ability to undergo surgical resection.

Results:  Baseline PFT scores varied with smoking status. Mean levels of diffusing capacity of the lung for carbon monoxide (Dlco) adjusted for hemoglobin declined 8% from pre- to postinduction (Wilcoxon signed rank test, p < 0.0001). Changes in FVC, FEV1, and total lung capacity were not statistically significant after chemotherapy. Although 27% of patients in the study had some reduction in PFT results, only 2 of the 85 eligible patients did not undergo surgery due to PFT reduction following chemotherapy. One patient in the study experienced a clinically significant respiratory toxicity (grade 3 dyspnea). Pulmonary toxicity was only statistically associated with male gender.

Conclusion:  In the preoperative setting, gemcitabine-based chemotherapy was well tolerated. The most commonly affected PFT parameter postchemotherapy was the Dlco. Although 15% of patients had a significant reduction in the Dlco postchemotherapy, it did not correlate with clinical symptoms or affect the ability to undergo surgical resection.


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