Prospective Multicentered Safety and Feasibility Pilot for Endobronchial Intratumoral Chemotherapy

• Published in: Chest Vol. 156; no. 3; pp. 562 - 570
• Main Authors: Yarmus, Lonny, Mallow, Christopher, Akulian, Jason, Lin, Cheng Ting, Ettinger, David, Hales, Russell, Voong, Kinh Ranh, Lee, Hans, Feller-Kopman, David, Semaan, Roy, Seward, Kirk, Wahidi, Momen M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2019; American College of Chest Physicians
• Subjects: Aged; airway obstruction; Airway Obstruction - etiology; Airway Obstruction - surgery; Antineoplastic Agents, Phytogenic - administration & dosage; Bronchoscopy; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; chemotherapy; Feasibility Studies; Female; Humans; Injections, Intralesional; interventional bronchoscopy; lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Male; Middle Aged; Paclitaxel - administration & dosage; Prospective Studies; Quality of Life; Stents; Thoracic Oncology; Treatment Outcome; airway obstruction; lung cancer; MCAO; FACT-L TOI; EITC; TBNA; HRQOL; MAO; FACT-L TOT; chemotherapy; interventional bronchoscopy; KPS
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2019.02.006

Malignant airway obstruction (MAO) occurs in 30% of patients with advanced-stage lung cancer, leading to debilitating dyspnea, cough, and hemoptysis. Other than recanalization of the airways, these patients lack long-lasting palliative therapy. The goal of this study was to determine the safety and feasibility of local injection of paclitaxel into the airway wall with a novel microinjection catheter. In this multicentered prospective trial, 23 patients with non-small cell lung cancer and MAO were enrolled from July 2014 through June 2016 to undergo rigid bronchoscopy with recanalization, followed by injection of 1.5 mg of paclitaxel with a novel injection catheter. Primary end points consisted of safety (adverse events, severe adverse events, and unanticipated adverse device effects) as well as feasibility (number of injections, injection success). Secondary end points consisted of airway patency improvement, quality of life metrics, and need for further interventions and/or stenting. Nineteen patients underwent rigid bronchoscopy with successful recanalization and paclitaxel injection. There were no adverse events, severe adverse events, or unanticipated adverse device effects. There was an average of 3.4 injections given for a total dose of 1.5 mg of paclitaxel in all patients. There was significantly less stenosis postprocedure vs preprocedure (25%-50% vs 75%-90%; P < .001), which was unchanged at 6 weeks (25%-50%). None of the participants required further interventions or airway stenting. The injection of paclitaxel after recanalization of MAO in patients with non-small cell lung cancer is safe and feasible, using a novel airway injection device. ClinicalTrials.gov; No.: NCT02066103; URL: www.clinicaltrials.gov