The antifibrotic agent nintedanib as a single agent appears to show some effectiveness in controlling both concurrent IPF and NSCLC, Australian clinicians have reported.
The limited evidence comes in part from a small number of case reports including that of a recent Sydney patient published in Respirology Case Reports.
The Australian case was a 78-year-old female, a former smoker with no relevant occupational or environmental exposures, diagnosed with stage IIIB lung adenocarcinoma and underlying IPF.
Standard treatment of concurrent chemotherapy and radiotherapy was contraindicated due to the risk of worsening pulmonary fibrosis from radiotherapy.
“There was furthermore significant concern regarding the use of anti‐PDL‐1 immunotherapy due to the risk of drug‐induced pneumonitis,” the case report from the Medical Oncology and Respiratory Departments of Blacktown Hospital said.
The patient was therefore initially treated with carboplatin/gemcitabine as palliative chemotherapy followed by maintenance pemetrexed with palliative intent.
However she developed worsening dyspnoea then bone marrow suppression and worsening renal function, “likely due to pemetrexed” and was deemed ineligible for further chemotherapy.
“Meanwhile, her underlying ILD had progressed with worsening of bilateral subpleural reticulation. She had a negative autoimmune/myositis panel. Following discussion in our ILD multidisciplinary meeting, the patient was commenced on nintedanib 150 mg BD in June 2019 without a lung biopsy.”
In March 2019 her lung cancer lesion had measured 17 × 13 mm.
“Besides diarrhoea, she tolerated the nintedanib well. Progress CT imaging showed improving pulmonary fibrosis but, interestingly, there was further progressive reduction in the size of the lung cancer, measuring 7 × 4 mm in July 2021.”
The case report said nintedanib can exhibit anti-cancer effects due to the inhibition of angiogenesis via blocking VEGF, PDGF and FGF.
The case report said further research into the treatment of concurrent IPF and NSCLC was warranted, and especially as it may be particularly useful for patients poorly tolerant of conventional chemotherapy.