Lung cancer in patients with fibrosing interstitial lung diseases – An overview of current knowledge and challenges

  1. Namrata Kewalramani1,
  2. Carlos Machahua1,2,
  3. Venerino Poletti3,
  4. Jacques Cadranel4,
  5. Athol U Wells5 and
  6. Manuela Funke-Chambour1,2⇑
  1. 1Department for BioMedical Research DBMR, Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
  2. 2Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
  3. 3Department of Thoracic Diseases, “GB. Morgagni” Hospita, Forlì, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES) University of Bologna, Italy
  4. 4Department of Pulmonary Medicine and Thoracic Oncology; Constitutive Reference Center of Rare Pulmonary Diseases, AP-HP, Hôpital Tenon and GRC04 Theranoscan, Sorbonne Université, Paris, France
  5. 5Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
  1. Corresponding author: Manuela Funke-Chambour (manuela.funke-chambour{at}insel.ch)

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.

Footnotes

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Conflict of interest: Dr. Kewalramani reports grants and non-financial support from CSL Behring, from null, outside the submitted work.

Conflict of interest: Dr. Machahua has nothing to disclose.

Conflict of interest: Dr. POLETTI reports personal fees from Boerhinger Ing, personal fees from Roche, personal fees from AMBU, personal fees from ERBE, outside the submitted work.

Conflict of interest: Dr. Cadranel reports fees for participation to boards of experts for the development of cancer drugs from AbbVie, AZ, BI, BMS, Jansen, MSD, Novartis, Pfizer, Roche and Takeda.

Conflict of interest: Dr. Wells reports personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from Bayer and Roche Pharmaceuticals, personal fees from Blade, outside the submitted work.

Conflict of interest: Dr. Funke-Chambour reports grants from Boehringer Ingelheim, grants from Roche, other from MSD, outside the submitted work.

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  • Received March 1, 2022.
  • Accepted April 18, 2022.
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