Impact of interstitial lung disease and simultaneous lung cancer on therapeutic possibilities and survival

Abstract

BackgroundFibrosing interstitial lung diseases (ILDs) are associated with poor survival and an increased risk of developing lung cancer (LC). Patient and LC characteristics, therapeutic possibilities and survival in this rare patient population are not well established.MethodsFibrosing ILD patients treated at the Department of Pulmonology Semmelweis University were reviewed retrospectively between 2012–2018 (N = 160). All patients with concomitant LC (N = 23) underwent detailed pulmonary evaluation. Cancer characteristics including driver mutation data, as well as therapy and survival were analyzed.ResultsILD‐LC patients (56% men, mean age 73 ± 6 years) had mild‐moderate lung functional impairment (forced vital capacity [FVC]: 80 ± 24%ref., forced expiratory volume in one second [FEV1]: 76 ± 27%ref.; transfer factor of the lung for carbon monoxide [TLCO]: 62 ± 25% reference). In 56% of cases histology confirmed adenocarcinoma followed by squamous cell carcinoma in 26%. Lobectomy could only be performed in one case; driver mutation was present in one patient. Chemotherapy was most commonly administered; however, 26% could only receive supportive palliative care. Four idiopathic pulmonary fibrosis patients received concomitant nintedanib to their LC treatment. Median survival of ILD‐LC patients was only 321 days.ConclusionsDiagnosis and therapy of ILD‐LC is challenging and patients have a very limited survival. A significant proportion of patients could only receive palliative care indicating the need for better management strategies in this special patient population. The evaluation of the effect of cotreatment with antifibrotics needs further study.Key points Interstitial lung diseases are often associated with lung cancer Diagnosis is challenging and therapy often limited due to underlying lung disease. Patients received platinum based chemotherapy or only supportive care.

Autoimmune Progressive Fibrosing Interstitial Lung Disease: Predictors of Fast Decline

“…The third variable for confirmed faster progression of PF-ILD in our patients was malignancy. Malignancy as a comorbidity is a serious complication associated with ILDs, especially in those showing progression as published previously in our previous study ( Barczi et al, 2020 ).…”

“…At baseline and every follow-up, physical examination was performed, and a detailed medical history was taken with special emphasis on symptoms (dry/productive cough, sputum, and chest pain), respiratory infections, and comorbidities ( Barczi et al, 2020 ). In our clinical routine, studied autoantibodies were anti-nuclear antibodies (ANA), rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (ACPA), anti-RNA polymerase, anti-centromere, anti-proliferating cell nuclear antigen (APCNA), anti-Ku, anti-P-ribosomal, anti-cytoplasmatic, anti-cytoskeleton, anti-chromatin, anti-Smith, anti-myeloperoxidase, anti-proteinase-3, anti-Jo-1, anti-SS-A, anti-SS-B, anti-SCL-70, anti-ribonucleoprotein (RNP), and anti-neutrophil cytoplasmic antibodies (ANCA).…”

Impact of sarcopenia on chemotherapy‐triggered exacerbation of interstitial lung disease in patients with non‐small cell lung cancer

“… 2 , 7 , 8 Therefore, patients with lung cancer and ILD often do not receive chemotherapy. 42 , 43 On the other hand, given evidence suggesting that chemotherapy may prolong survival, uniformly excluding these populations from chemotherapy may not be appropriate. 5 , 6 The present study showed that patients without sarcopenia were less prone to ILD exacerbation and could hence receive aggressive chemotherapy, which may contribute to a better prognosis.…”

“…First, this was a single‐center retrospective study with a relatively small sample size, which may have introduced bias. However, lung cancer with ILD is a rare disease with a limited number of patients 3 , 4 , 9 , 10 , 12 , 13 , 14 , 42 , 45 The number of patients included herein does not considerably differ from those included in other studies. Moreover, given the absence of large‐scale phase III trials in patients with ILD‐complicated lung cancer to date, evidence has largely been obtained from retrospective studies.…”

Glasgow prognostic score for prediction of chemotherapy‐triggered acute exacerbation interstitial lung disease in patients with small cell lung cancer

“…Conversely, ILD is reported in 10%-30% of patients with lung cancer, [10][11][12][13][14][15] seriously affecting prognosis. 12,[16][17][18][19][20][21] This is because of the limited availability of effective chemotherapy approaches and exacerbation of treatment-related ILD. 5,18 Studies exclusively conducted in patients with small cell lung cancer (SCLC) have reported incidence rates of chemotherapy-triggered acute exacerbation (AE)-ILD ranging from 11.9% to 36.4%.…”