Tumor cavitation during therapy with antiangiogenesis agents in patients with lung cancer

PURPOSE: Treatment of lung cancer patients with antiangiogenesis agents is a new promising paradigm. Tumor cavitation is frequently noted in these patients, but the clinical significance of this finding has not been fully determined. Our purposes were to evaluate the frequency, imaging characteristics, and clinical outcome of patients receiving antiangiogenesis agents who develop tumor cavitation, and correlate these findings with therapy related adverse events, especially hemoptysis. METHODS: Retrospective analysis of lung cancer patients treated with antiangiogenesis agents in MD Anderson Cancer Center between June 1998 and June 2005. Clinical data were retrieved from medical records, and chest imaging findings were documented. RESULTS: One hundred and twenty-four patients were treated in 10 different trials. All patients had advanced lung cancer and failed previous chemotherapy. Seventeen patients developed tumor cavitation during the trial (14%; median time to event, 1.8 months; range, 0.7-6.2 months), 16 patients (13%) had preexisting cavitary tumors, and 91 (73%) did not develop cavitation. Cavity formation was more common with squamous cell histology (p = 0.04) but was not associated with hemoptysis (p = 0.12), tumor location (central versus peripheral), imaging characteristics, progression-free survival (p = 0.56), or overall survival (p = 0.33). Hemoptysis was noted in five patients (median time to event, 1.3 months; range, 0.8-2.9 months). One of five patients with hemoptysis was fatal in a cavitary squamous cell tumor. Additional adverse events were hypertension, rash, and proteinuria, none associated with cavitation. CONCLUSION: Development of tumor cavitation is not rare in lung cancer patients treated with antiangiogenesis agents, but the clinical implications are minimal in most cases.