Lung cancer in patients with fibrosing interstitial lung diseases: an overview of current knowledge and challenges

Abstract

Patients with progressive fibrosing interstitial lung diseases (fILD) have increased morbidity and mortality. Lung fibrosis can be associated with lung cancer (LC). The pathogenesis of both diseases shows similarities although not all mechanisms are understood. The combination of the diseases is challenging, due to its amplified risk of mortality and also because lung cancer treatment carries additional risks in patients with underlying lung fibrosis. Acute exacerbations in fILD patients are linked to increased mortality and the risk of acute exacerbations is increased after LC treatment with surgery, chemotherapy, or radiotherapy. Careful selection of treatment modalities is crucial to improve survival whilst maintaining acceptable quality of life in patients with combined LC and fILD. This overview of epidemiology, pathogenesis, treatment, and a possible role for antifibrotic drugs in patients with LC and fILD is the summary of a session presented during the virtual ERS conference 2021. The review summarises current knowledge and identifies areas of uncertainty. Most current data relate to patients with combined idiopathic pulmonary fibrosis and LC. There is a pressing need for additional prospective studies, required for the formulation of a consensus statement or guideline on the optimal care of patients with LC and fILD.

BAL Proteomic Signature of Lung Adenocarcinoma in IPF Patients and Its Transposition in Serum Samples for Less Invasive Diagnostic Procedures

“…Antifibrotic therapies decelerate the disease progression and, consequently, increase the survival of IPF patients. However, increased survival due to delayed disease progression leads to a higher prevalence of comorbidities and complications [ 5 ]. Indeed, many patients with IPF also have other comorbid conditions that include emphysema, pulmonary hypertension, sleep apnoea, coronary artery disease, and lung cancer (LC) [ 6 ].…”

Pharmacotherapy for lung cancer with comorbid interstitial pneumonia: limited evidence requires appropriate evaluation

“…To the Editor, We have read with interest the article entitled "Lung cancer in patients with fibrosing interstitial lung diseases: an overview of current knowledge and challenges" by Kewalramani N et al 1 About 10% of lung cancer patients are complicated with interstitial pneumonia (IP) and have a poor prognosis. Although there is a lack of evidence in this area, the article clearly summarizes the current status from epidemiology to treatment, and is very informative for clinicians.…”

“…We have read with interest the article entitled “Lung cancer in patients with fibrosing interstitial lung diseases: an overview of current knowledge and challenges” by K ewalramani et al . [ 1 ]. ∼10% of lung cancer patients are complicated with interstitial pneumonia and have a poor prognosis.…”

Reply to: Pharmacotherapy for lung cancer with comorbid interstitial pneumonia: limited evidence requires appropriate evaluation

“…We appreciate the interest raised by our recent article [ 1 ] and take the opportunity to address the points raised by Y. Ishida and colleagues.…”

“…The primary end-point of reduced acute exacerbation rate was not met. A correction to our publication has now been published [ 1 ].…”