In Certain IPF Patients with Lung Cancer, Ofev May Be Best Treatment

Ofev, an approved treatment of idiopathic pulmonary fibrosis (IPF), may be considered as a monotherapy for patients who also have non‐small cell lung cancer and are unable to tolerate cancer chemotherapy, a case study reported. 

The study, “Effect of nintedanib on non‐small cell lung cancer in a patient with idiopathic pulmonary fibrosis: A case report and literature review,” was published in the journal Thoracic Cancer.

People with IPF are at an increased risk of lung cancer. In fact, up to 15% of lung cancer patients have IPF.

As those with IPF are typically excluded from clinical trials testing lung cancer therapies, optimal treatment for people with both conditions has not been established. 

Ofev (nintedanib, by Boehringer Ingelheim) is an approved anti-fibrotic therapy for IPF. It has been shown to suppress lung function decline and lower the risk of exacerbation. 

In combination with the chemotherapy Taxotere (docetaxel), Ofev is used after first‐line chemotherapy in patients with advanced non‐small cell lung cancer (NSCLC) in European Union countries.

In support of this approach, researchers at Hirosaki University School of Medicine Graduate School of Medicine in Japan reported on the case of a 69‐year‐old man with a history of smoking, who had been diagnosed with advanced NSCLC. 

Initial high-resolution CT scans found a honeycombing pattern in his lungs — a sign of IPF. The first-line treatment prescribed was the chemotherapy combination of Paraplatin (carboplatin), Alimta (pemetrexed), and bevacizumab (sold under several brand names).

After he failed to respond, a second-line chemotherapy combination of Taxotere and Cyramza (ramucirumab) was attempted, which was followed by a third-line treatment of Paraplatin plus Teysuno (S-1). 

Despite these treatments, the patient’s IPF and NSCLC had progressed. He was then given supplemental oxygen therapy and, to provide the best supportive care, Ofev was started to treat IPF. 

On the first day of Ofev treatment, given at 150 mg twice a day, his vital signs were normal except for abnormally rapid breathing (tachypnea). An increase in liver enzymes following Ofev administration, suggesting potential liver toxicity, was successfully treated with ursodiol (ursodeoxycholic acid).

One month later, chest CT scans revealed the primary lung tumor and surrounding cancer tissue had regressed.

Although the patient did not experience further IPF-related exacerbations, he was readmitted to the hospital due to excess fluid around the lungs and lung failure. He eventually died of cancer progression. 

Nonetheless, these data suggest that Ofev monotherapy might “be effective for some patients with NSCLC and IPF who are unable to tolerate cytotoxic chemotherapy,” the researchers wrote. 

Further studies are needed.