Ofev Prevents IPF, Lung Cancer Progression in Case of Woman, 75
Treatment with Ofev (nintedanib) was found to prevent the progression of both cancer and idiopathic pulmonary fibrosis (IPF) in a 75-year-old woman with a history of smoking who was diagnosed with IPF and diffuse squamous cell lung cancer, a recent case study reported.
Nevertheless, researchers noted that “scientific data are still scarce regarding the benefits of [Ofev] in patients with IPF-associated lung cancer, and it is unclear whether [Ofev] could have a preventive role in lung carcinogenesis in IPF patients.”
IPF is a respiratory lung disease of unknown origin that’s characterized by the formation of scar tissue (fibrosis) in the lungs, which makes it difficult for patients to breathe.
Studies have indicated that up to 22% of IPF patients go on to develop lung cancer, with a nearly fivefold increased risk as compared with the general population. However, no clear connection between the two diseases has been confirmed.
The researchers here noted, however, that both diseases are known to have similar features and mechanisms, particularly the involvement of multiple growth factors — molecules involved in cell growth and proliferation. “IPF patients diagnosed with lung cancer have a poorer prognosis than patients with IPF alone,” the team, from France, also noted.
This case report described a Caucasian woman, age 75 at the time of initial treatment, with a history of smoking, who was hospitalized for breathlessness in November 2016.
Her medical history included an irregular heart rhythm that was treated with the blood thinner warfarin, high blood pressure treated with a beta blocker, and gastroesophageal reflux — a digestive disorder in which stomach contents back up into the esophagus.
Additionally, the woman ran a bar/tobacco shop, where she had significant long-term exposure to others’ tobacco smoke.
Her clinical exam revealed dyspnea, or difficulty breathing, and abnormal lung sounds. Imaging of her chest showed signs of lung disease, although her blood tests, bronchoscopy, and bronchoalveolar lavage were all normal. Of note, bronchoscopy is a procedure that enables physicians to look at a patient’s lungs and air passages using a thin lighted tube; in a bronchoalveolar lavage procedure, a fluid sample is collected from the lungs.
Lung function tests showed signs of obstruction in the large air passages that go down to the lungs from the mouth and nose, as well as an impairment in the lungs’ ability to take in oxygen from the air.
Clinicians decided to perform a lung biopsy to determine whether the patient had IPF. Two samples were taken from the right lung, and both specimens showed a pattern indicative of IPF.
Additionally, one of the samples showed signs indicative of invasive squamous cell carcinoma — a type of lung cancer — which was limited to a particular area and had not spread to the membrane that covers the lungs. The tumor was then surgically removed.
In September 2017, A PET-CT scan, an imaging procedure that looks at increased glucose (blood sugar) uptake into cells — indicative of cancer — showed some mildly increased glucose uptake, but there were no nodules, masses, or enlarged lymph nodes that could indicate the presence of cancer. Clinicians found no need for anti-tumor medications at the time.
However, at a multidisciplinary meeting a month later, they decided to prescribe the patient Ofev, an anti-fibrotic medication, given the confirmation of IPF. Ofev was specifically chosen, the researchers said, because of its known anti-tumor properties due to its effects on cell proliferation.
At a follow-up visit on October 2019 — two years after starting treatment with Ofev — the patient’s clinical, lung function tests, and scans were all stable with no evidence of IPF or cancer progression.
“We report a case of IPF diagnosed on surgical lung biopsy, associated with diffuse [squamous cell lung cancer] without any nodule, mass, or lymph node found on chest CT or PET–CT,” the researchers wrote, adding that this emphasizes the connection between structural changes associated with IPF and cancer occurrence.
“After 3 years of [Ofev] treatment, which was administered for its antifibrotic and antitumor properties, both IPF and [squamous cell lung cancer] show no sign of progression,” they wrote.