ILD and lung cancer: an unfortunate combination of events

'When it rains, it pours.'

That's what patients must think when they are diagnosed with both interstitial lung disease (ILD) and lung cancer. Unfortunately, this combination of diseases happens more often than would be expected on the basis of mere chance. Portugese researchers evaluated therapeutical options for these patients that appear to be caught between a rock and a hard place.

The incidence of lung cancer is increased 5-fold in patients with idiopathic pulmonary fibrosis (IPF), compared with the general population, according to Linhas and colleagues in the Portuguese Journal of Pulmonology. On top of that, specific forms of ILD may also increase the likelihood of getting lung cancer. This concomitant occurrence of ILD and lung cancer poses a challenge for the clinical practice, because treatment of one disease might negatively influence the symptoms or the course of the other disease.

Chemotherapy for example, plays an irreplaceable role in the treatment of lung cancer, but patients with both lung cancer and ILD that receive chemotherapy may face risks of chemotherapy-related acute exacerbation of ILD. So far, no consensus has been reached, nor has enough evidence been presented to support an optimal treatment strategy for patients with lung cancer and ILD. An additional disadvantage for these patients is that they are usually excluded by most clinical trials, which makes it hard to find decisive evidence for the best treatment of this specific group of patients. 

As of now, treatment of the lung cancer should be considered in patients presenting both lung cancer and ILD, but interdisciplinary evaluation of therapeutic options is mandatory. Apart from this, the patient opinion should also be considered for the final decision. Prospective studies about the treatment of lung cancer in ILD patients are urgently needed and might open up new possibilities for this very unfortunate patient group. 

References:
Linhas R, et al. Concomitant lung cancer and interstitial lung disease: A challenge in clinical practice. Rev Port Pneumol. 2016. http://dx.doi.org/10.1016/j.rppnen.2016.11.008