Effect of nintedanib on non‐small cell lung cancer in a patient with idiopathic pulmonary fibrosis: A case report and literature review

Abstract

Nintedanib has been approved for the treatment of idiopathic pulmonary fibrosis (IPF). In addition, in EU countries, nintedanib plus docetaxel is used for patients with advanced non-small cell lung cancer (NSCLC) after first-line chemotherapy. Here, we report a case of advanced NSCLC in a patient with IPF successfully treated with nintedanib monotherapy. A 69-year-old man was diagnosed with NSCLC complicated by IPF. After three lines of chemotherapy, he still had progressive disease. Because his IPF had also progressed, requiring supplemental oxygen, we decided to start best supportive care and introduced nintedanib to treat his IPF. One month later, we observed a partial remission of the primary tumor and pleural disseminations without severe adverse events. Nintedanib monotherapy might therefore be an effective therapeutic choice for NSCLC in patients with IPF who are unable to tolerate cytotoxic chemotherapy. Key points:• Efficacy of nintedanib administered in a NSCLC patient with IPF.• Nintedanib monotherapy might be a therapeutic option for NSCLC patients with IPF who are unable to tolerate chemotherapy.

Remarkable response of non‐small cell lung cancer to nintedanib treatment in a patient with idiopathic pulmonary fibrosis

“…One case of squamous cell carcinoma and IPF was treated with nintedanib, 7 which inhibited tumor progression for 9 months. The second report was a case of NSCLC complicated by IPF 8 ; 1 month following nintedanib, partial remission of the primary tumor and pleural dissemination was observed. Nintedanib also promotes antitumor immunity and antitumor activity in combination with PD‐1 blockade in mice 9…”

Integrated computational analysis revealed hub genes in lung adenocarcinoma

“…Most of these drugs are inhibitors in nature. Only a few of the TOP2A and MELK targeting drugs have been used for the treatment of lung cancer such as etoposide (topoisomerase II inhibiting anti-cancer drug) has been used for treating NSLC [38], dexrazoxane (a catalytic inhibitor of DNA topoisomerase II that lack double stranded DNA break activity) possess with protective function against anthracycline-induced cardiotoxicity and extravasation injuries, has been administered with cyclophosphamide, adriamycin and vincristine (Advanced small cell lung cancer treated with CAV [39], sunitinib (a tyrosine kinase inhibitor possessing broad antitumor e cacy) [40] and nintedanib (inhibitor of receptor tyrosine kinase and nonreceptor tyrosine kinase) along with docetaxel is administered for NSCLC patients after rst-line chemotherapy in European countries [41]. Further investigation and clinical trials are needed to explore the mechanism of these drugs that could be effective against lung cancer.…”

Drugs that act on the respiratory tract

“…Pirfenidone has been studied as a perioperative therapy in patients undergoing surgical resection of primary lung cancer ( Kanayama et al, 2020 [c]), as well as a maintenance therapy in patients with unclassifiable progressive fibrosing interstitial lung disease ( Maher et al, 2020 [C]) and systemic sclerosis-related interstitial lung disease ( Acharya et al, 2020 [c]). Nintedanib use has been reported in progressive interstitial lung disease ( Wells et al, 2020 [C]), non-small cell lung cancer with IPF ( Shiratori et al, 2020 [A]), idiopathic-inflammatory-myopathy-related interstitial lung disease ( Liang et al, 2021 [c]), rheumatoid arthritis-related interstitial lung disease ( Narváez et al, 2020 [A]; Vacchi et al, 2020 [A]), systemic sclerosis-related interstitial lung disease ( Azuma et al, 2021 [C]; Bournia et al, 2021 [R]; Highland et al, 2021 [C]; Kuwana et al, 2021 [c]; Seibold et al, 2020 [C]), bronchiolitis obliterans syndrome after allogenic haematopoietic stem cell transplantation ( Tang et al, 2020 [A]), and for pulmonary fibrosis after coronavirus disease 2019 ( Ogata et al, 2021 [A]). The incidence, type, and severity of nintendanib and pirfenidone associated adverse events in these reports is consistent with what has been previously reported for these agents in clinical trials for IPF.…”