Bleomycin-triggered Lung Disease May Be Treated with Esbriet, Case Report Suggests

A case report illustrates the possibility of treating cancer patients who develop bleomycin-triggered lung disease with Esbriet (pirfenidone) — a drug approved for idiopathic pulmonary fibrosis (IPF) treatment.

Researchers acknowledged that further studies are needed, but they said combining Esbriet and corticosteroid drugs could completely reverse lung disease and prevent fibrosis in these patients.

The study, “Combined prednisolone and pirfenidone in bleomycin-induced lung disease,” was published in the Journal of Cancer Research and Therapeutics.

Bleomycin is a potent anti-cancer drug that is often used to treat patients with Hodgkin’s disease, as well as testicle and uterus cancers. Lung disease triggered by the medication is most often treated with corticosteroids.

The team at Fortis Hospitals in India described two cancer patients who were able to recover with a combination of corticosteroids and Esbriet. The two — a 55-year-old woman and a 45-year-old man — had both received five to six rounds of chemotherapy, which included bleomycin, for Hodgkin’s lymphoma.

They developed shortness of breath, rapid heart rate, and had low levels of oxygen saturation in their blood. Lung-function tests showed that they had a very limited forced vital capacity (FVC, a measure of lung function) — about 30% predicted.

Chest scans showed lung changes indicating interstitial disease, and in the case of the man, there were early fibrotic signs. Since extensive evaluations did not indicate that the lung disease was caused by an infection or other factors, physicians concluded it was from exposure to bleomycin.

The woman was treated with 40 mg of prednisolone once a day, 600 mg of n‑acetylcysteine three times a day, and 200 mg of Esbriet three times per day. Doctors increased the Esbriet dose to 400 mg after three weeks. The prednisolone was tapered and stopped after eight weeks.

She was treated with Esbriet and n‑acetylcysteine for six months, during which her lung function improved. The changes seen on the chest scans gradually disappeared, and her FVC improved to 74% predicted. She returned to full-time work after a year.

The man initially was treated with just prednisolone, during which time his condition worsened. He then received the same treatment regimen as the woman.

His Esbriet dose was escalated to 1,800 mg, and because he did not tolerate n-acetylcysteine, his treatment continued with just prednisolone and Esbriet. His lung FVC improved to 88% predicted.

He was able to return to work after six months of treatment.