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Drakopanagiotakis F, Krauss E, Michailidou I, Drosos V, Anevlavis S, Günther A, Steiropoulos P. Lung Cancer and Interstitial Lung Diseases. Cancers (Basel) 2024; 16:2837. [PMID: 39199608 PMCID: PMC11352559 DOI: 10.3390/cancers16162837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/01/2024] [Accepted: 08/11/2024] [Indexed: 09/01/2024] Open
Abstract
Lung cancer continues to be one of the leading causes of cancer-related death worldwide. There is evidence of a complex interplay between lung cancer and interstitial lung disease (ILD), affecting disease progression, management strategies, and patient outcomes. Both conditions develop as the result of common risk factors such as smoking, environmental exposures, and genetic predispositions. The presence of ILD poses diagnostic and therapeutic challenges in lung cancer management, including difficulties in interpreting radiological findings and increased susceptibility to treatment-related toxicities, such as acute exacerbation of ILD after surgery and pneumonitis after radiation therapy and immunotherapy. Moreover, due to the lack of large, phase III randomized controlled trials, the evidence-based therapeutic options for patients with ILDs and lung cancer remain limited. Antifibrotic treatment may help prevent pulmonary toxicity due to lung cancer treatment, but its effect is still unclear. Emerging diagnostic modalities and biomarkers and optimizing personalized treatment strategies are essential to improve outcomes in this patient population.
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Affiliation(s)
- Fotios Drakopanagiotakis
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.D.); (S.A.)
| | - Ekaterina Krauss
- European IPF Registry & Biobank (eurIPFreg/Bank), 35394 Giessen, Germany; (E.K.); (A.G.)
- Center for Interstitial and Rare Lung Diseases, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35394 Giessen, Germany
| | - Ira Michailidou
- Department of Pneumonology, General Anti-Cancer Oncological Hospital, Agios Savvas, 11522 Athens, Greece;
| | - Vasileios Drosos
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, 97070 Würzburg, Germany;
| | - Stavros Anevlavis
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.D.); (S.A.)
| | - Andreas Günther
- European IPF Registry & Biobank (eurIPFreg/Bank), 35394 Giessen, Germany; (E.K.); (A.G.)
- Center for Interstitial and Rare Lung Diseases, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35394 Giessen, Germany
- Agaplesion Lung Clinic, 35753 Greifenstein, Germany
- Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Justus-Liebig University Giessen, 35394 Giessen, Germany
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.D.); (S.A.)
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2
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Yan S, Xue S, Wang T, Gao R, Zeng H, Wang Q, Jia X. Efficacy and safety of nintedanib in patients with non-small cell lung cancer, and novel insights in radiation-induced lung toxicity. Front Oncol 2023; 13:1086214. [PMID: 37637045 PMCID: PMC10449572 DOI: 10.3389/fonc.2023.1086214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Nintedanib is a tyrosine kinase inhibitor of fibroblast growth factor-, vascular endothelial growth factor-, and platelet-derived growth factor receptors. These three receptors promote new blood vessel formation and maintenance, which is essential for tumor growth and spread. Several trials have shown that nintedanib plays a substantial role in treating patients with non-small cell lung cancer (NSCLC) and idiopathic pulmonary fibrosis. Recently, several clinical trials of nintedanib to treat NSCLC have been reported. In this review, we focus on our current understanding of nintedanib treatment for advanced NSCLC patients and summarize the literature on using nintedanib in radiation-induced lung toxicity and the efficacy and tolerability of nintedanib.
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Affiliation(s)
| | | | | | | | | | | | - Xiaojing Jia
- Department of Tumor Radiotherapy, The Second Hospital of Jilin University, Changchun, China
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3
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Chen S, Gao D, Sun R, Bao J, Lu C, Zhang Z, Xiao T, Gu X, Zhou H. Anlotinib prove to be a potential therapy for the treatment of pulmonary fibrosis complicated with lung adenocarcinoma. Pulm Pharmacol Ther 2023; 80:102202. [PMID: 36906117 DOI: 10.1016/j.pupt.2023.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/13/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
Pulmonary fibrosis is a chronic interstitial fibrosis lung disease with high mortality, which is often complicated with lung cancer. The incidence of IPF complicated with lung cancer is getting higher and higher. At present, there is no consensus on the management and treatment of pulmonary fibrosis patients with lung cancer. There is an urgent need to develop preclinical drug evaluation methods for IPF with lung cancer and potential therapeutic drugs for IPF with lung cancer. The pathogenic mechanism of IPF is similar to that of lung cancer, and the multi-effect drugs with anticancer and anti-fibrosis will have potential value in the treatment of IPF complicated with lung cancer. In this study, we established an animal model of IPF complicated with lung cancer in situ to evaluate the therapeutic effect of the antiangiogenic drug anlotinib. The pharmacodynamic results in vivo showed that anlotinib could significantly improve the lung function of IPF-LC mice, reduce the content of collagen in lung tissue, increase the survival rate of mice, and inhibit the growth of lung tumor in mice. The results of Western blot and immunohistochemical analysis of lung tissue showed that anlotinib significantly inhibited the expression of fibrosis marker protein α-SMA, Collagen I and Fibronectin and tumor proliferation marker protein PCNA in mouse lung tissue, and down-regulated the content of serum tumor marker CEA. Through transcriptome analysis, we found that anlotinib regulates MAPK signal pathway, PARP signal pathway and coagulation cascade signal pathway in lung cancer and pulmonary fibrosis, which all play an important role in lung cancer and pulmonary fibrosis. In addition, there is crosstalk between the signal pathway participated by the target of anlotinib and MAPK, JAK/STAT and mTOR signal pathway. In summary, anlotinib will be a candidate for IPF-LC treatment.
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Affiliation(s)
- Shanshan Chen
- The First Affiliated Hospital of Zhengzhou University, 1 Longhu Middle Ring Road, Zhengzhou, Jinshui District, Henan Province, People's Republic of China.
| | - Dandi Gao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin, 300353, People's Republic of China.
| | - Ronghao Sun
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin, 300353, People's Republic of China.
| | - Jiali Bao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin, 300353, People's Republic of China.
| | - Chunya Lu
- The First Affiliated Hospital of Zhengzhou University, 1 Longhu Middle Ring Road, Zhengzhou, Jinshui District, Henan Province, People's Republic of China
| | - Zihui Zhang
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin, 300353, People's Republic of China
| | - Ting Xiao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin, 300353, People's Republic of China.
| | - Xiaoting Gu
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin, 300353, People's Republic of China.
| | - Honggang Zhou
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin, 300353, People's Republic of China.
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4
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Pan L, Meng F, Wang W, Wang XH, Shen H, Bao P, Kang J, Kong D. Nintedanib in an elderly non-small-cell lung cancer patient with severe steroid-refractory checkpoint inhibitor-related pneumonitis: A case report and literature review. Front Immunol 2023; 13:1072612. [PMID: 36703957 PMCID: PMC9872202 DOI: 10.3389/fimmu.2022.1072612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Immune checkpoint inhibitors tremendously improve cancer prognosis; however, severe-grade immune-related adverse events may cause premature death. Current recommendations for checkpoint inhibitor-related pneumonitis (CIP) treatment are mainly about immunosuppressive therapy, and anti-fibrotic agents are also needed, especially for patients with poor response to corticosteroids and a longer pneumonitis course. This is because fibrotic changes play an important role in the pathological evolution of CIP. Here, we report a case demonstrating that nintedanib is a promising candidate drug for CIP management or prevention, as it has potent anti-fibrotic efficacy and a safety profile. Moreover, nintedanib could partially inhibit tumor growth in patients with non-small-cell lung cancer, and its efficacy can be improved in combination with other anti-tumor therapies.
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Affiliation(s)
- Lei Pan
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Fanqi Meng
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,The First Clinical College, China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Xu-hao Wang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,The First Clinical College, China Medical University, Shenyang, China
| | - Hui Shen
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Pengchen Bao
- The First Clinical College, China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Delei Kong
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,*Correspondence: Delei Kong,
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Zlatanova T, Arabadjiev J, Kirova-Nedyalkova G, Nikova D. Successful treatment with docetaxel plus nintedanib in a patient with lung adenocarcinoma and pulmonary fibrosis: A case report and literature review. Front Oncol 2022; 12:907321. [PMID: 36016602 PMCID: PMC9396293 DOI: 10.3389/fonc.2022.907321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
Despite the rare incidence of idiopathic pulmonary fibrosis (IPF), coexisting IPF and lung cancer is common. Both diseases have unfavorable outcomes and are often associated with impaired quality of life. In this study, we present a clinical case of a patient with coexisting IPF and lung adenocarcinoma who was successfully treated with nintedanib plus docetaxel as a second-line treatment, and achieved a substantial improvement in the quality of life. To our knowledge, very few cases in the literature address the concurrent treatment of both diseases, which makes this case a valuable illustration of a successful treatment strategy and a basis for future investigations.
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Affiliation(s)
- Tanya Zlatanova
- Department of Medical Oncology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
- *Correspondence: Tanya Zlatanova,
| | - Jeliazko Arabadjiev
- Department of Medical Oncology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | | | - Diana Nikova
- Clinic of Pneumology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Small Cell Lung Cancer in the Course of Idiopathic Pulmonary Fibrosis—Case Report and Literature Review. Curr Oncol 2022; 29:5077-5083. [PMID: 35877261 PMCID: PMC9318736 DOI: 10.3390/curroncol29070401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a poorly prognosed form of progressive interstitial pneumonia. Patients with IPF have a significantly increased risk of developing lung cancer, which further worsens the course of the disease. The most common histological types of LC among patients with IPF are squamous cell carcinoma and adenocarcinoma. Furthermore, all LC treatment modalities can lead to developing an acute IPF exacerbation. In this report, we present a rare case of coexistence of IPF and small cell lung cancer in a 76-year-old patient with chronic obstructive pulmonary disease, and a former smoker. For over 2 years, the patient was treated with an anti-fibrotic drug-pirfenidone, which slowed down the progression of IPF. Unfortunately, after being diagnosed with an active SCLC, the patient was excluded from further participation in the pirfenidone drug program. SCLC is characterized by high aggressiveness, rapid growth and high metastatic potential; therefore, it is necessary to apply antitumor treatment as soon as possible. The described patient was treated with carboplatin–etoposide chemotherapy. Early treatment tolerance was good and after two cycles of cytotoxic treatment, a partial response was present in CT. The presented case emphasizes the need for further research to determine the treatment regimens in patients with coexisting IPF and LC and the appropriateness of antifibrotic treatment in them. In addition, it can help to choose the treatment method for similar patients, indicating a combination of carboplatin and etoposide as an effective and, at the same time, relatively safes method in terms of the risk of IPF’s exacerbation.
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Alamshany ZM, Tashkandi NY, Othman IMM, Anwar MM, Nossier ES. New thiophene, thienopyridine and thiazoline-based derivatives: Design, synthesis and biological evaluation as antiproliferative agents and multitargeting kinase inhibitors. Bioorg Chem 2022; 127:105964. [PMID: 35759881 DOI: 10.1016/j.bioorg.2022.105964] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
Multitargeting kinase inhibitors recently proved to be a profitable approach for conquering cancer proliferation. The current study represents the design and synthesis of new thiophene, thienopyridine, and thiazoline-based derivatives 4-14a,b. All the target compounds were examined in vitro against three cancer cell lines; the liver (HepG-2), breast (MCF-7), and colon (HCT-116) where the thiophene-based compounds 5a-c, demonstrated the most potent activity. Furthermore, the latter derivatives revealed a safety profile against WI-38 normal cell line of selectivity indices ranging from 4.43 to 17.44. In vitro enzyme assay of 5a-c revealed that the carbohydrazide analog 5c has the most promising multitargeting inhibiting activity against Pim-1, VEGFR-2, and EGFRWT enzymes of IC50 values; 0.037 ± 0.02, 0.95 ± 0.24, and 0.16 ± 0.05 µM, respectively. As it was the most potent analog, 5c was further subjected to cell cycle and apoptosis analysis. The results indicated that it induced preG1 arrest and an apoptotic effect in the early and late stages. Moreover, further apoptosis studies were carried out for 5c to evaluate its proapoptotic potential. Interestingly, 5c enhanced the levels of Bax/Bcl-2 ratio, p53, and active caspase 3 by 18, 6.4, and 24 folds, respectively compared to the untreated cells. The antimicrobial evaluation showed that only compounds 3 and 5a produced broad-spectrum potency, while 5b and 5c exhibited outstanding antifungal effects. Finally, a molecular docking study was carried out to discover the probable interactions of compound 5c with the active sites of Pim-1, VEGFR-2, and EGFRWT kinases.
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Affiliation(s)
- Zahra M Alamshany
- Department of Chemistry, Faculty of Science, King Abdulaziz University, Jeddah 21551, P.O. Box 42805, Saudi Arabia
| | - Nada Y Tashkandi
- Department of Chemistry, Faculty of Science, King Abdulaziz University, Jeddah 21551, P.O. Box 42805, Saudi Arabia
| | - Ismail M M Othman
- Department of Chemistry, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
| | - Manal M Anwar
- Department of Therapeutic Chemistry, National Research Centre, Dokki, Cairo 12622, Egypt.
| | - Eman S Nossier
- Pharmaceutical Medicinal Chemistry and Drug Design Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo 11754, Egypt.
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Dabholkar S, Gao B, Chuong B. Nintedanib-A case of treating concurrent idiopathic pulmonary fibrosis and non-small cell lung cancer. Respirol Case Rep 2022; 10:e0902. [PMID: 35059200 PMCID: PMC8756078 DOI: 10.1002/rcr2.902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
Treating advanced lung cancer in patients with pulmonary fibrosis can be challenging due to increased risks of drug-induced and radiation-induced pneumonitis. We present the case of a 78-year-old female with stage IIIB lung adenocarcinoma and idiopathic pulmonary fibrosis (IPF). Following partial response to platinum-based chemotherapy, she was started on maintenance pemetrexed, but this was stopped due to bone marrow suppression and kidney injury. She received no further chemotherapy. Nintedanib was subsequently commenced for treatment of IPF. Remarkably, progress imaging at 2 years showed further regression of her lung adenocarcinoma, with stability of IPF. Nintedanib is a multi-target tyrosine kinase inhibitor with anti-cancer effects due to inhibition of angiogenesis. Nintedanib with chemotherapy has shown improvements in survival in non-small cell lung cancer (NSCLC). This case report and literature review discuss the effectiveness of nintedanib in treating patients with concurrent IPF and NSCLC, in particular for patients poorly tolerant of conventional chemotherapy.
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Affiliation(s)
- Shakti Dabholkar
- Respiratory DepartmentBlacktown HospitalSydneyNew South WalesAustralia
| | - Bo Gao
- Medical Oncology DepartmentBlacktown HospitalSydneyNew South WalesAustralia
| | - Brian Chuong
- Respiratory DepartmentBlacktown HospitalSydneyNew South WalesAustralia
- University of NSWSydneyNew South WalesAustralia
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9
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Surgical treatment for patients with idiopathic pulmonary fibrosis and lung cancer: postoperative acute exacerbation of idiopathic pulmonary fibrosis and outcomes. Surg Today 2021; 52:736-744. [PMID: 34347162 DOI: 10.1007/s00595-021-02343-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 01/01/2023]
Abstract
Postoperative exacerbation of interstitial pneumonia in patients with interstitial lung disease and lung cancer has emerged as a serious problem. Therefore, we need to determine the risk factors for the development of postoperative exacerbation of interstitial pneumonia in this population. There are several subtypes of interstitial lung disease, which may lead to confusion about the treatment of patients with interstitial lung disease and lung cancer. Among the idiopathic forms of interstitial lung disease, we focused on idiopathic pulmonary fibrosis (IPF) and reviewed the surgical treatments used for patients with IPF and lung cancer.
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Zhang X, Li W, Li C, Zhang J, Su Z. Chemotherapy in idiopathic pulmonary fibrosis and small-cell lung cancer with poor lung function. BMC Pulm Med 2021; 21:122. [PMID: 33858421 PMCID: PMC8051081 DOI: 10.1186/s12890-021-01489-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease with unclear pathogenesis. IPF is considered as a risk factor for lung cancer. Compared to other lung cancers, small-cell lung cancer (SCLC) has a lower incidence, but has a more aggressive course. Patients with IPF and SCLC have a lower survival rate, more difficult treatment, and poorer prognosis. Case presentation Case 1 was of a 66-year-old man with IPF for 5 years, who was admitted to our hospital for dyspnea. Case 2 was of a 68-year-old woman, who presented with chest pains, cough, and dyspnea. Both patients had extremely poor lung function. High-resolution computed tomography and pathology revealed that both patients had IPF and SCLC. Chemotherapy comprising nedaplatin (80 mg/m2) and etoposide (100 mg for 5 days) was initiated for both patients. Antifibrotic agents were continued during the chemotherapeutic regimen. Both patients showed improvement in their condition after treatment. Conclusion The favorable outcomes in these 2 cases suggests that chemotherapy is worth considering in the management of patients having SCLC and IPF with poor lung function.
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Affiliation(s)
- Xiyue Zhang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Chunyan Li
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Zhenzhong Su
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China.
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Kai Y, Matsuda M, Fukuoka A, Hontsu S, Yamauchi M, Yoshikawa M, Muro S. Remarkable response of non-small cell lung cancer to nintedanib treatment in a patient with idiopathic pulmonary fibrosis. Thorac Cancer 2021; 12:1457-1460. [PMID: 33742758 PMCID: PMC8088921 DOI: 10.1111/1759-7714.13935] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
Nintedanib is a multi‐target receptor tyrosine kinase inhibitor that reduces the decline in forced vital capacity (FVC) and prevents acute exacerbations in idiopathic pulmonary fibrosis (IPF), which is a risk factor for lung cancer. However, it remains unclear whether nintedanib is an effective treatment for lung cancer in patients with IPF. Here, we describe an 82‐year‐old man with non‐small cell lung carcinoma complicated by IPF who was treated with nintedanib. High‐resolution computed tomography (HRCT) showed a subpleural basal‐predominant reticular shadow and traction bronchiectasis with a honeycomb pattern. His FVC decreased over time, and his 6‐min walk test showed oxygen desaturation. Furthermore, an enlarged nodular lesion was detected after 6 months of referral. Biopsy confirmed non‐small cell carcinoma. Because of the risk of acute exacerbation of IPF by chemotherapy, supportive care was selected. Nintedanib was started as treatment for the IPF. Nine months later, HRCT revealed partial remission without exacerbation of IPF. This case indicates the possibility of nintedanib monotherapy in suppressing lung cancer complicated by IPF. Patients with lung cancer complicated by IPF in whom treatment is effective remain unknown. Additional research is needed to identify effective therapy for lung cancer with IPF.
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Affiliation(s)
- Yoshiro Kai
- Department of Respiratory Medicine, Minami-Nara General Medical Center, Nara, Japan
| | - Masayuki Matsuda
- Department of Respiratory Medicine, Minami-Nara General Medical Center, Nara, Japan
| | | | - Shigeto Hontsu
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Masanori Yoshikawa
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
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12
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Shiratori T, Tanaka H, Tabe C, Tsuchiya J, Ishioka Y, Itoga M, Taima K, Takanashi S, Tasaka S. Effect of nintedanib on non-small cell lung cancer in a patient with idiopathic pulmonary fibrosis: A case report and literature review. Thorac Cancer 2020; 11:1720-1723. [PMID: 32285615 PMCID: PMC7262881 DOI: 10.1111/1759-7714.13437] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Toshihiro Shiratori
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | - Chiori Tabe
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | - Junichiro Tsuchiya
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | - Yoshiko Ishioka
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | - Masamichi Itoga
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | - Kageaki Taima
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Takanashi
- Health Administration Center, Hirosaki University, Hirosaki, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Japan
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13
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Valenzuela C, Torrisi SE, Kahn N, Quaresma M, Stowasser S, Kreuter M. Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme. Respir Res 2020; 21:7. [PMID: 31906942 PMCID: PMC6945404 DOI: 10.1186/s12931-019-1269-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023] Open
Abstract
The approvals of nintedanib and pirfenidone changed the treatment paradigm in idiopathic pulmonary fibrosis (IPF), and increased our understanding of the underlying disease mechanisms. Nonetheless, many challenges and unmet needs remain in the management of patients with IPF and other progressive fibrosing interstitial lung diseases.This review describes how the nintedanib clinical programme has helped to address some of these challenges. Data from this programme have informed changes to the IPF diagnostic guidelines, the timing of treatment initiation, and the assessment of disease progression. The use of nintedanib to treat patients with advanced lung function impairment, concomitant emphysema, patients awaiting lung transplantation and patients with IPF and lung cancer is discussed. The long-term use of nintedanib and an up-to-date summary of nintedanib in clinical practice are discussed. Directions for future research, namely emerging therapeutic options, precision medicine and other progressive fibrosing interstitial lung diseases, are described.Further developments in these areas should continue to improve patient outcomes.
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Affiliation(s)
- Claudia Valenzuela
- Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sebastiano Emanuele Torrisi
- University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Manuel Quaresma
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Susanne Stowasser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany.
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Gao L, Jiang D, Geng J, Dong R, Dai H. Hydrogen inhalation attenuated bleomycin-induced pulmonary fibrosis by inhibiting transforming growth factor-β1 and relevant oxidative stress and epithelial-to-mesenchymal transition. Exp Physiol 2019; 104:1942-1951. [PMID: 31535412 DOI: 10.1113/ep088028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/17/2019] [Indexed: 01/15/2023]
Abstract
NEW FINDINGS • What is the central question of this study? The aim was to explore the effects and underlying mechanisms of H2 on bleomycin-induced pulmonary fibrosis. • What are the main findings and its importance? Our results indicate that, in bleomycin-induced pulmonary fibrosis, H2 inhalation attenuated oxidative stress and reversed the pulmonary epithelial-to-mesenchymal transition process by reducing reactive oxygen species production and inhibiting the expression of transforming growth factor-β1, α-smooth muscle actin and collagen I to improve fibrotic injury and exert anti-fibrogenic effects. Thus, H2 inhalation has promising therapeutic potential as a useful adjuvant treatment for patients with idiopathic pulmonary fibrosis, which deserves further study and evaluation. ABSTRACT Hydrogen (H2 ) can protect against tissue damage. The effect of H2 inhalation therapy on the pathogenesis of pulmonary fibrosis remains unknown. This study was designed to explore the effects and underlying mechanisms of H2 inhalation on bleomycin (BLM)-induced pulmonary fibrosis. A rat model of pulmonary fibrosis was established with BLM. Rats were randomly divided into control and H2 inhalation groups. Haematoxylin and Eosin staining and Mason's Trichrome staining were performed to evaluate pulmonary fibrosis injury, inflammatory cell infiltration, structural disorder and collagen deposition. qRT-PCR and western blot assays were used to determine the expression of TNF-α, TGF-β1, α-SMA, E-cadherin, N-cadherin, vimentin, VEGF and collagen type I at both mRNA and protein levels. The contents of reactive oxygen species, TGF-β1, TNF-α, malondialdehyde and hydroxyproline were determined with biochemical test kits or ELISA kits. Bleomycin-stimulated rats exhibited typical symptoms of pulmonary fibrosis, which featured an increase in collagen deposition, alveolitis, fibrosis and parenchymal structural disorder in the lung. However, BLM-induced oxidative stress was attenuated by H2 inhalation therapy, which reduced the contents of reactive oxygen species, malondialdehyde and hydroxyproline, enhanced the activity of glutathione peroxidase and decreased the expression of TGF-β1 and TNF-α. In addition, H2 inhalation also inhibited BLM-induced epithelial-to-mesenchymal transition by inhibiting TGF-β1, increasing the expression level of the epithelial cell marker E-cadherin, and decreasing the expression level of the mesenchymal cell marker vimentin in a time-dependent manner. In addition, H2 inhalation downregulated α-SMA expression and suppressed collagen I generation, exerting anti-fibrogenic effects. Hydrogen inhalation therapy attenuates BLM-induced pulmonary fibrosis by inhibiting TGF-β1, relevant oxidative stress and epithelial-to-mesenchymal transition.
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Affiliation(s)
- Li Gao
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, China
| | - Dingyuan Jiang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jing Geng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Run Dong
- Department of Respiratory Medicine, Zhengzhou Central Hospital, Zhengzhou, China
| | - Huaping Dai
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
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