Lung Cancer Patients with IPF and Emphysema at Higher Risk of Flares, Study Says

People with non-small cell lung cancer (NSCLC) who also have pulmonary fibrosis and emphysema are at a greater risk of acute flares following cancer treatment that includes chemotherapy, surgery, or radiotherapy, a study from South Korea reports.

The study “Combined pulmonary fibrosis and emphysema and idiopathic pulmonary fibrosis in non-small cell lung cancer: impact on survival and acute exacerbation” was published in the journal BMC Pulmonary Medicine.

Evidence suggests  that both idiopathic pulmonary fibrosis (IPF) and emphysema are associated with an increased risk of lung cancer. (Emphysema corresponds to an enlargement of the air sacks — called alveoli — in the lungs, reducing the area available for oxygen transport.)

Although IPF and emphysema are separate conditions, studies are increasingly finding they co-exist in patients, and a new term — combined pulmonary fibrosis and emphysema (CPFE) — was proposed by a research team in 2015 to describe people with both.

Patients with CPFE are also suspected of being at a greater risk for lung cancer and to have a higher mortality rate than those with emphysema. But CPFE’s course as its own illness and its likely complications are not well understood, especially when it is present in people who also have lung cancer.

Researchers in South Korea evaluated the impact of both IPF and CPFE on outcomes of non-small cell lung cancer (NSCLC) patients.

They performed a retrospective analysis of clinical and lab data covering 283 people diagnosed with NSCLC between November 2003 and February 2018 at two hospitals in South Korea. The majority were men (95.1%); 107 (37.8%) of these 282 patients had CPFE, and 176 (62.2%) had IPF. Their mean age was 70.3.

CPFE patients had a heavier smoking history and poorer lung function compared to IPF patients, as shown by the results of two standard lung tests.  In an exam measuring patients’ diffusion capacity of carbon monoxide (DLco), scores 64.8% (CPFE) and 78% (IPF);  scores in the ratio between forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were 71.2% (CPFE) and 75.1% (IPF).

Results also showed that people with NSCLC and CPFE had a tendency to develop more acute exacerbations (21.3%) than the IPF group (13.1%), although the difference was not statistically significant. (Acute exacerbations, or flares, were defined as worsening within one month after treatment including chemotherapy, surgery, or radiotherapy.)

The team found no significant differences in survival rates between the IPF and CPFE groups.

Of the NSCLC patients whose data were analyzed, 71.7% died: 71.6% in the CPFE group after a follow-up of 18.6 months, and 72% in the IPF group after 24.1 months follow-up.

Data showed a significant correlation with a risk of acute exacerbations in people with CPFE and a lung cancer stage higher than 2, according to the Gender-Age-Physiology (GAP) index system (a scoring system for predicting mortality in IPF patients).

Findings suggested that the risk for acute flares “was higher in patients with CPFE and NSCLC, but all-cause mortality was not higher in NSCLC patients with concomitant CPFE than in those with concomitant IPF,” the researchers wrote.

“Physicians should be aware of the increased risk of AE [acute exacerbations] when treating NSCLC patients with CPFE. A multidisciplinary approach is required for treating these patients,” they added.