The Importance of Driver-Targeted Therapy Among Patients With Lung Cancer Initially Diagnosed in the Intensive Care...

Patients who had been diagnosed with lung cancer during intensive care unit (ICU) admission showed poor prognosis. This research investigated the clinical characteristics related to the outcomes of these patients and focused on the potential benefit of driver-targeted therapy.

From February 2011 to October 2022, we included patients who were initially diagnosed with lung cancer during ICU admission in Taichung Veterans General Hospital. We evaluated their clinicopathological factors, overall survival, and hospital discharge outcome.

We included a total of 57 patients. The most frequent reasons for ICU entry were central nervous system metastasis (36.8%), respiratory tract infections (26.3%), and tumor with main airway compression (15.8%). The median APACHE II score was 23 (range: 6-40). Bronchoscopy (47.4%) followed by brain craniotomy (22.8%) were the most common biopsy methods, while adenocarcinoma (68.4%) accounted for the most common histology. Eighteen patients received driver-targeted therapy. Tumor as the primary reason for ICU admission (aOR 4.90 [95% CI 1.22-19.6], p = 0.025) and driver-targeted therapy (aOR 2.80 [95% CI 1.01-7.69], p = 0.048) both independently predicted a higher chance of ventilator-independent hospital discharge. Significant factors for a longer overall survival included tumor as the primary reason for ICU admission (aHR 0.63 [95% CI 0.40-0.99], p = 0.046), a lower baseline APACHE II score (aHR 0.62 [95% CI 0.40-0.96], p = 0.031), and driver-targeted therapy (aHR 0.17 [95% CI 0.05-0.51], p = 0.002).

Driver-targeted therapy was associated with a favorable hospital discharge outcome and a longer overall survival. Performing a biopsy to confirm diagnosis and oncogenic driver(s) testing are recommended.