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Cancer drug also 'slows progress' of fatal lung disease

A major international study has found that a drug previously used as a cancer treatment can significantly slow the progression of a fatal lung disease.

Nintedanib has been found by the research team led by Southampton General Hospital to halve the annual decline in breathing capacity normally seen in patients diagnosed with idiopathic pulmonary fibrosis (IPF).

The condition, which is part of a group of disorders known collectively as interstitial lung disease, causes inflammation and scarring of the lung tissue and sufferers have an average life expectancy of between just three and five years – worse tan many cancers.

IPF affects around 15,000 people over 60 in the UK, mainly men and former smokers, and is responsible for 5,000 deaths and 5,000 new cases every year.

“The drug may become available to at least some patients within the next few months”

Luca Richeldi

Nintedanib is the first treatment to specifically target key molecules known to cause fibrosis in the lungs of patients with the condition.

It works by blocking the signals sent by enzymes known as tyrosine kinases which, without intervention, go on to activate the disease by creating excess tissue build-up and scarring and, as a result, block the passage of oxygen.

The studies, led by Professor Luca Richeldi, a consultant in respiratory medicine at Southampton General Hospital, involved 1,066 patients from 205 centres in 24 countries in the Americas, Europe, Asia and Australia.

It compared the lung function of 638 patients who received nintedanib with 423 who received a placebo in two replicate 52-week studies by testing the amount of air participants could expel after their deepest breath, known as forced vital capacity.

In the first study, the decline in breathing capacity of 309 patients who received treatment was cut by more than half (52%), with an average loss of 114.7ml of air compared with 239.9ml among the placebo patients.

The second study saw a similar reduction in decline (45%), with an average loss of 113.6ml of lung capacity in 329 patients on medication compared with 207.3ml among the 219 on placebos.

The average annual reduction in healthy individuals is between 30 to 50ml of air over a year.

In addition, nintedanib delayed the onset of patients’ first severe respiratory attack – known as an acute exacerbation – with only 5% of patients suffering at least one event compared with 8% in the placebo group.

Professor Richeldi, who is chair of interstitial lung disease at the University of Southampton, said the findings would offer patients a “new direction” in treatment.

Southampton General Hospital

Luca Richeldi

He said: “Nintedanib specifically targets some key molecular pathways known to be involved in IPF, which gives us a much clearer insight into how the body works and how we might be able to further develop treatments.”

He added: “The impact of this study cannot be overstated. These are exciting results and mean nintedanib has the potential to offer patients a new direction in treating this aggressive disease.”

The study was funded by Boehringer Ingelheim. They were presented on Sunday at the international conference of the American Thoracic Society in San Diego and published online by the New England Journal of Medicine.

Professor Richeldi said it was now “highly likely” the drug would be licensed worldwide within the next year, but may be available to some patients in the near future.

He said: “We expect an advance use programme to begin in Europe before next summer, so the drug may become available to at least some patients within the next few months.”

Dr Penny Woods, chief executive of the British Lung Foundation, said: “We welcome the results of the trials presented at ATS this year and we hope that they will take us a step further in treating patients and understanding the devastating disease that is IPF.

“The level of knowledge and understanding of IPF seriously lags behind that of other diseases,” she said. “Only a significant increase in research investment will help bring about the improvements needed to bridge this gap and bring IPF treatment into the 21st century.”

 

Readers' comments (2)

  • My brother had this little understood disease. He was diagnosed in January this year, had three hospitalizations and was buried 13 days ago.Treatment is not the same as with COPD. My poor brother was told he had "scarring" of his lungs. Why wasn't his life-limiting disease given it's proper name? You have to know your enemy if you want to put up a fight. Before the last hospitalization I asked if he could have medicine for anxiety. I believed, as did the primary care doctor, that there was a risk of suppressing respirations. However, when I read up on treatment of symptoms, oxygen, benzodiazepines and low dose morphine were stressed. The evening we were told my brother would not be coming home, I begged for morphine to bel started. I was told, repeatedly, that his morphine was only ordered for pain - a complaint he denied. I am glad that, short of lung transplant, there is some hope for patients with stiff lungs. However, for most patients, symptom control is most essential.

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  • My mother sadly passed away in March after struggling with IPFD for 2 years. It is the most awful disease to watch someone you love struggle for breath in the later stages of this disease. Although my mother had been told there was nothing that could be done because she had not been told that it was worse than being diagnosed with cancer the thought that it that she was dying never entered her head. Please let everyone know about this dreadful disease and let's improve care for everyone know about this little known diagnosus

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