Surgery is the most effective option to treat lung cancer in people with less severe idiopathic pulmonary fibrosis (IPF), a Korean study has found.
For IPF patients who have a poorer prognosis (more advanced GAP stages), researchers recommend accounting for cancer clinical stage and estimated tolerability to anti-cancer treatments when deciding on surgery.
These findings were reported in the study, “Prognosis of non-small-cell lung cancer in patients with idiopathic pulmonary fibrosis,” published in the journal Nature Scientific Reports.
People diagnosed with IPF are at greater risk of lung cancer, as both conditions share common risk factors. However, no standard approach is established for the treatment of lung cancer in these patients.
Lack of treatment guidelines is in part due to the low overall survival of IPF patients, and because anti-cancer treatments led to a higher rate of complications such as acute flares of pulmonary fibrosis.
Recognizing the need to know which cancer treatments most benefit IPF patients, Korean researchers evaluated the effectiveness and overall clinical outcomes of different lung cancer treatments in 160 IPF patients who had non-small-cell lung cancer (NSCLC) — a type of malignancy that accounts for 85–90% of all lung cancers.
All patients were followed between 2003 and 2016 in South Korea’s Seoul National University Bundang Hospital. Nearly all patients were men (94.4%); their mean age was 70.
The research team reviewed patients’ clinical records, taking into account the severity of lung cancer and the severity of IPF, in contrast with prior studies that primarily focused on treatments according to cancer stage.
They classified all participants according to lung cancer stage and GAP stage — a three-stage prognosis index for IPF based on gender, age, and lung function values. The higher the GAP stage, the poorer the outcome and predicted risk of death.
Of the 160 patients, 22 received conservative therapy as first-line cancer therapy, while 69 underwent surgery, 58 received chemotherapy, and 11 radiation therapy.
For patients in GAP stage I, and among all treatment modalities, those who underwent surgery were the only ones to have a significantly longer life, both in terms of time without disease worsening and overall survival. In contrast, no significant differences were noted among patients in GAP stage II/III, either at early or advanced stages of cancer, regardless of the cancer treatment approach used.
Patients who had advanced cancer (stage IV) and poorer functional status, as determined by the ECOG Performance Status score, were found to have a substantially shorter lifespan. Smoking also was also found to be linked with poorer outcomes in patients in GAP stages II and III.
In general, acute IPF flares occurred in one (4.5%), 10 (14.5%), seven (12.1%), and four (36.4%) patients at the time they received conservative therapy, surgery, chemotherapy, or radiotherapy. These adverse events were more common among patients at advanced GAP stages.
During the study period, 6.3% of the participants died, a poor outcome that was mainly due to IPF flares among patients with GAP stage II/III disease.
“Our study showed that surgery was an effective treatment modality for GAP stage I patients with [lung cancer], while other treatment modalities of LC failed to show effectiveness regardless of the GAP stage,” researchers said.
Based on this finding, the team recommends that active treatment should be considered in IPF patients with GAP stage I, whereas for patients with more advanced IPF, their ECOG scores and cancer stage should be taken into consideration when deciding on the necessity of surgery.