Ofev May Help Treat IPF With Lung Cancer, Case Report Suggests

A patient with idiopathic pulmonary fibrosis (IPF) who also had non-small cell lung cancer responded well to treatment with Ofev (nintedanib), according to a new case report.

The findings suggest Ofev might be an effective treatment choice for patients in whom the two conditions coexist but who are unable to tolerate chemotherapy to treat the lung cancer.

Ofev had a strong and unexpected anti-tumor effect in this elderly patient, the researchers said.

The case report, “Remarkable response of non‐small cell lung cancer to nintedanib treatment in a patient with idiopathic pulmonary fibrosis,” was published in the journal Thoracic Cancer by researchers from Japan.

Lung cancer is a common coexisting condition in IPF, with an estimated prevalence of 2.7% to 48% in this patient population.

“The prognosis of patients with IPF is negatively influenced by lung cancer,” the researchers wrote. However, the best treatment option for these patients has yet to be established.

The report describes the case of an 82-year-old man with a history of type 2 diabetes who was treated at the hospital for suspicion of lung disease.

Initial high-resolution computed tomography (CT) scans revealed a honeycomb pattern — a sign of IPF — along with a nodule or a small growth adjacent to the left lower lung lobe. Seven months later, the patient’s forced vital capacity (FVC), a measure of lung function, had decreased. Moreover, a six-minute walk test revealed oxygen desaturation, or a drop in oxygen levels, and it was found that the lung nodule had increased in size.

After examining a sample of tissue taken from the lung nodule, doctors diagnosed the man with primary non-small cell lung cancer. The cancer already had spread to the pleura, a thin membrane surrounding the lungs, and to lymph nodes in the chest cavity.

However, the patient and his family refused chemotherapy as a lung cancer treatment.

“Treatment for lung cancer complicated by IPF is often challenging because of chemotherapy‐induced exacerbation of IPF,” the researchers wrote.

Therefore, the patient was started on palliative care for the lung cancer and Ofev at a dosage of 100 milligrams twice daily for IPF.

Boehringer Ingelheim’s Ofev, marketed as Vargatef in the European Union, is an anti-fibrotic therapy approved for IPF. It works by blocking the formation of scar tissue in the lungs, thus slowing down the decline of lung function and lowering the risk of acute exacerbations or flare-ups.

Six months after starting treatment with Ofev, CT scans revealed that the primary tumor had shrunk and the spread to nearby organs had been reduced.

“We did not expect the antitumor effect, which was observed by chance,” the researchers wrote. “Nintedanib [Ofev] caused regression of the lung cancer, … and lung function remained stable.”

One month later, the Ofev dosage was increased to 150 milligrams twice daily — the recommended dose for this therapy.

“This case indicates the possibility of nintedanib [Ofev] monotherapy in suppressing lung cancer complicated by IPF,” the researchers wrote.

The team noted that another group of researchers also had reported a case of a patient with IPF and non-small cell lung cancer whose tumor decreased in size after treatment with Ofev.

However, “further research is warranted for identifying predictive factors that may help in the selection of appropriate treatments for individual patients with lung cancer complicated by IPF,” the researchers concluded.