Students Association at the Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-950 Lublin, Poland.
Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-950 Lublin, Poland.
Curr Oncol. 2022 Jul 18;29(7):5077-5083. doi: 10.3390/curroncol29070401.
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.
特发性肺纤维化是一种预后不良的进行性间质性肺炎。IPF 患者发生肺癌的风险显著增加，这进一步恶化了疾病的进程。在 IPF 患者中，最常见的 LC 组织学类型是鳞状细胞癌和腺癌。此外，所有 LC 治疗方法都可能导致急性 IPF 恶化。在本报告中，我们介绍了一例罕见的慢性阻塞性肺疾病、曾吸烟者 76 岁患者同时存在特发性肺纤维化和小细胞肺癌的病例。2 年来，患者一直接受抗纤维化药物吡非尼酮治疗，该药物减缓了 IPF 的进展。不幸的是，在被诊断为活动性小细胞肺癌后，患者被排除在进一步参与吡非尼酮药物计划之外。小细胞肺癌的特点是侵袭性高、生长迅速、转移潜能高；因此，有必要尽快应用抗肿瘤治疗。所述患者接受了卡铂依托泊苷化疗。早期治疗耐受性良好，在两个周期的细胞毒性治疗后，CT 显示部分缓解。该病例强调需要进一步研究确定同时存在 IPF 和 LC 的患者的治疗方案以及在这些患者中应用抗纤维化治疗的适宜性。此外，它可以帮助选择类似患者的治疗方法，表明卡铂和依托泊苷联合应用是一种有效且同时在 IPF 恶化风险方面相对安全的方法。
