Managing lung cancer in idiopathic pulmonary fibrosis patients is difficult, largely because standard lung cancer treatments create a risk of IPF exacerbations and patients dying early.
The research, “Lung Cancer in Patients with Severe Idiopathic Pulmonary Fibrosis: Critical Aspects,” was published in the journal in vivo,
Although scientists do not know how the illnesses are connected, studies have shown that up to 15 percent of IPF patients develop lung cancer within five years of their diagnosis. Moreover, among those who survive for 10 years, more than half have lung cancer.
But treating lung cancer in these vulnerable patients, who often have other illnesses as well, is no easy task, researchers at Careggi University Hospital noted.
Lung cancer treatments or even invasive cancer diagnostic procedures can trigger IPF exacerbations in the majority of patients, and cancer surgery puts about 20 percent at risk of death. Chemotherapy and radiation also increase the risk of IPF exacerbations.
The researchers illustrated the treatment difficulties with case studies of four patients. All were older men, and two had medical conditions besides lung fibrosis.
Doctors found what they suspected to be lung cancer lesions on chest images during or soon after the men’s IPF diagnoses. In all four cases, physicians deemed it too risky to perform invasive procedures to obtain samples of the suspected tumors, or remove them by surgery.
Instead, doctors treated three of the patients with Ofev. Liver and kidney disease, as well as other health problems, prevented the fourth patient from receiving Ofev.
The first patient had deteriorated rapidly by the time physicians detected a suspected lung tumor. But after a year of Ofev, his IPF had stabilized, with no further decline in lung function. Interestingly, the suspected tumor also stabilized. The other two patients began receiving Ofev in 2016, and doctors have yet to make the treatment results available.
Nintedanib and the chemotherapy docetaxel are an approved combo therapy for the treatment of non-small cell lung cancer. For that purpose, it is sold under the brand name Vargatef and not Ofev.
The Italian team noted that no studies have examined nintedanib’s effectiveness as a stand-alone therapy in IPF patients with lung cancer. That’s particularly true of the dose of 150 mg twice a day that is commonly given to IPF patients.
“It would be a really relevant goal to understand if these patients have any benefits from this treatment,” the researchers wrote.
Such research could answer questions such as whether Ofev can stabilize both the fibrotic disease and cancer, and whether people who have not had first-line cancer chemotherapy can benefit from it.