# The Fibrotic–Cancer Continuum in IPF: Shared Mechanisms, Clinical Implications and Therapeutic Challenges

**Authors:** Panagiota Tsiri, Marousa Kouvela, Ourania Papaioannou, Vasilina Sotiropoulou, Matthaios Katsaras, Nikolaos Syrigos, Fotios Sampsonas, Argyrios Tzouvelekis

PMC · DOI: 10.3390/life16020295 · 2026-02-09

## TL;DR

This paper explores the link between idiopathic pulmonary fibrosis and lung cancer, focusing on shared mechanisms and treatment challenges.

## Contribution

The paper highlights shared molecular mechanisms and therapeutic targets between IPF and lung cancer, offering new insights for treatment strategies.

## Key findings

- Lung scarring in IPF may increase the risk of developing lung cancer.
- Common genetic and epigenetic markers exist between IPF and lung cancer.
- Anti-cancer drugs like nintedanib show promise in treating IPF.

## Abstract

Idiopathic pulmonary fibrosis represents a chronic, progressive, lethal lung disease of various etiologies exerting a dramatic impact on patients’ survival and quality of life. Its increasing prevalence and high mortality rates indicate the importance of early diagnosis and management involving the assessment of specific comorbidities, such as lung cancer. Emerging evidence suggests that in the context of IPF, lung scarring may be a potential risk factor for lung cancer development. Both disease entities present pathogenic commonalities including genetic and epigenetic markers, signaling pathways and cell transformation obtaining mesenchymal phenotypes. Beyond understanding disease pathogenesis, anti-cancer drugs such as nintedanib have been successfully used to treat patients with IPF. Additionally, a therapeutic approach that includes a mix of various pleiotropic anti-fibrotic agents is currently being developed for IPF treatment. Currently, there is no consensus on the application of therapeutic algorithms in concurrent pulmonary fibrosis and lung tumors. This review summarizes the current state of knowledge on common cellular and molecular pathogenetic mechanisms of IPF and lung cancer and highlights potential therapeutic targets with fruitful results.

## Linked entities

- **Chemicals:** nintedanib (PubChem CID 135423438)
- **Diseases:** idiopathic pulmonary fibrosis (MONDO:0800029), lung cancer (MONDO:0005138)

## Full-text entities

- **Genes:** MMP1 (matrix metallopeptidase 1) [NCBI Gene 4312] {aka CLG}, TNFRSF11B (TNF receptor superfamily member 11b) [NCBI Gene 4982] {aka OCIF, OPG, PDB5, TR1}, SFRP1 (secreted frizzled related protein 1) [NCBI Gene 6422] {aka FRP, FRP-1, FRP1, FrzA, SARP2}, ACTA1 (actin alpha 1, skeletal muscle) [NCBI Gene 58] {aka ACTA, ASMA, CFTD, CFTD1, CFTDM, CMYO2A}, IGF2 (insulin like growth factor 2) [NCBI Gene 3481] {aka C11orf43, GRDF, IGF-II, PP9974, SRS3}, MGMT (O-6-methylguanine-DNA methyltransferase) [NCBI Gene 4255], EDN1 (endothelin 1) [NCBI Gene 1906] {aka ARCND3, ET1, HDLCQ7, PPET1, QME}, CDKN2A (cyclin dependent kinase inhibitor 2A) [NCBI Gene 1029] {aka ARF, CAI2, CDK4I, CDKN2, CMM2, INK4}, TP53 (tumor protein p53) [NCBI Gene 7157] {aka BCC7, BMFS5, LFS1, P53, TRP53}, YAP1 (Yes1 associated transcriptional regulator) [NCBI Gene 10413] {aka COB1, YAP, YAP-1, YAP2, YAP65, YKI}, THY1 (Thy-1 cell surface antigen) [NCBI Gene 7070] {aka CD90, CDw90}, SFTPA2 (surfactant protein A2) [NCBI Gene 729238] {aka COLEC5, ILD2, PSAP, PSP-A, PSPA, SFTP1}, BRAF (B-Raf proto-oncogene, serine/threonine kinase) [NCBI Gene 673] {aka B-RAF1, B-raf, BRAF-1, BRAF1, NS7, RAFB1}, SMAD4 (SMAD family member 4) [NCBI Gene 4089] {aka DPC4, JIP, MADH4, MYHRS}, CDKN1A (cyclin dependent kinase inhibitor 1A) [NCBI Gene 1026] {aka CAP20, CDKN1, CIP1, MDA-6, P21, SDI1}, CCN2 (cellular communication network factor 2) [NCBI Gene 1490] {aka CTGF, HCS24, IBP-8, IGFBP8, KMD, NOV2}, AKT1 (AKT serine/threonine kinase 1) [NCBI Gene 207] {aka AKT, PKB, PKB-ALPHA, PRKBA, RAC, RAC-ALPHA}, MYC (MYC proto-oncogene, bHLH transcription factor) [NCBI Gene 4609] {aka MRTL, MYCC, bHLHe39, c-Myc}, MUC5B (mucin 5B, oligomeric mucus/gel-forming) [NCBI Gene 727897] {aka MG1, MUC-5B, MUC5, MUC9}, FCGR1A (Fc gamma receptor Ia) [NCBI Gene 2209] {aka CD64, CD64A, FCG1, FCGR1, FCRI, FcgammaRI}, CCN1 (cellular communication network factor 1) [NCBI Gene 3491] {aka CYR61, GIG1, IBP-10, IGFBP-10, IGFBP10}, PWAR1 (Prader Willi/Angelman region RNA 1) [NCBI Gene 145624] {aka D15S227E, PAR-1, PAR1}, ENPP2 (ectonucleotide pyrophosphatase/phosphodiesterase 2) [NCBI Gene 5168] {aka ATX, ATX-X, AUTOTAXIN, LysoPLD, NPP2, PD-IALPHA}, TAFAZZIN (tafazzin, phospholipid-lysophospholipid transacylase) [NCBI Gene 6901] {aka BTHS, CMD3A, EFE, EFE2, G4.5, LVNCX}, PDCD1 (programmed cell death 1) [NCBI Gene 5133] {aka ADMIO4, AIMTBS, CD279, PD-1, PD1, SLEB2}, TNC (tenascin C) [NCBI Gene 3371] {aka 150-225, DFNA56, GMEM, GP, HXB, JI}, EPHB2 (EPH receptor B2) [NCBI Gene 2048] {aka BDPLT22, CAPB, DRT, EK5, EPHT3, ERK}, SPP1 (secreted phosphoprotein 1) [NCBI Gene 6696] {aka BNSP, BSPI, ETA-1, OPN}, TERC (telomerase RNA component) [NCBI Gene 7012] {aka DKCA1, PFBMFT2, SCARNA19, TER, TR, TRC3}, PIK3CB (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit beta) [NCBI Gene 5291] {aka P110BETA, PI3K, PI3KBETA, PIK3C1}, EGFR (epidermal growth factor receptor) [NCBI Gene 1956] {aka ERBB, ERBB1, ERRP, HER1, NISBD2, NNCIS}, IL13 (interleukin 13) [NCBI Gene 3596] {aka IL-13, P600}, CLCF1 (cardiotrophin like cytokine factor 1) [NCBI Gene 23529] {aka BSF-3, BSF3, CISS2, CLC, NNT-1, NNT1}, SFTPA1 (surfactant protein A1) [NCBI Gene 653509] {aka COLEC4, ILD1, PSP-A, PSPA, SFTP1, SFTPA1B}, CXCR4 (C-X-C motif chemokine receptor 4) [NCBI Gene 7852] {aka CD184, D2S201E, FB22, HM89, HSY3RR, LCR1}, CD274 (CD274 molecule) [NCBI Gene 29126] {aka ADMIO5, B7-H, B7H1, PD-L1, PDCD1L1, PDCD1LG1}, MIR21 (microRNA 21) [NCBI Gene 406991] {aka MIRN21, hsa-mir-21, miR-21, miRNA21}, CCND1 (cyclin D1) [NCBI Gene 595] {aka BCL1, D11S287E, PRAD1, U21B31}, CXCL6 (C-X-C motif chemokine ligand 6) [NCBI Gene 6372] {aka CKA-3, GCP-2, GCP2, SCYB6}, SETD2 (SET domain containing 2, histone lysine methyltransferase) [NCBI Gene 29072] {aka HBP231, HIF-1, HIP-1, HSPC069, HYPB, KMT3A}, GJA1 (gap junction protein alpha 1) [NCBI Gene 2697] {aka AVSD3, CMDR, CX43, EKVP, EKVP3, GJAL}, SHH (sonic hedgehog signaling molecule) [NCBI Gene 6469] {aka HHG1, HLP3, HPE3, MCOPCB5, SMMCI, ShhNC}, FHIT (fragile histidine triad diadenosine triphosphatase) [NCBI Gene 2272] {aka AP3Aase, FRA3B}, MIRLET7D (microRNA let-7d) [NCBI Gene 406886] {aka LET7D, MIRNLET7D, hsa-let-7d, let-7d}, PTK2B (protein tyrosine kinase 2 beta) [NCBI Gene 2185] {aka CADTK, CAKB, FADK2, FAK2, PKB, PTK}, CXCL12 (C-X-C motif chemokine ligand 12) [NCBI Gene 6387] {aka IRH, PBSF, SCYB12, SDF1, TLSF, TPAR1}, TERT (telomerase reverse transcriptase) [NCBI Gene 7015] {aka CMM9, DKCA2, DKCB4, EST2, PFBMFT1, TCS1}, IL6 (interleukin 6) [NCBI Gene 3569] {aka BSF-2, BSF2, CDF, HGF, HSF, IFN-beta-2}, PTK2 (protein tyrosine kinase 2) [NCBI Gene 5747] {aka FADK, FADK 1, FAK, FAK1, FRNK, PPP1R71}, MIR19A (microRNA 19a) [NCBI Gene 406979] {aka C13orf25, MIRH1, MIRHG1, MIRN19A, hsa-mir-19a, miR-19a}, ZMYND11 (zinc finger MYND-type containing 11) [NCBI Gene 10771] {aka BRAM1, BS69, MRD30}, MUC16 (mucin 16, cell surface associated) [NCBI Gene 94025] {aka CA125}, MTOR (mechanistic target of rapamycin kinase) [NCBI Gene 2475] {aka FRAP, FRAP1, FRAP2, RAFT1, RAPT1, SKS}, CDH2 (cadherin 2) [NCBI Gene 1000] {aka ACOGS, ADHD8, ARVD14, CD325, CDHN, CDw325}, MMP7 (matrix metallopeptidase 7) [NCBI Gene 4316] {aka MMP-7, MPSL1, PUMP-1}, SERPINA1 (serpin family A member 1) [NCBI Gene 5265] {aka A1A, A1AT, AAT, PI, PI1, PRO2275}, TGFB1 (transforming growth factor beta 1) [NCBI Gene 7040] {aka CAEND1, CED, DPD1, IBDIMDE, LAP, TGF-beta1}, RTEL1 (regulator of telomere elongation helicase 1) [NCBI Gene 51750] {aka C20orf41, DKCA4, DKCB5, NHL, PFBMFT3, RTEL}, FAS (Fas cell surface death receptor) [NCBI Gene 355] {aka ALPS1A, APO-1, APT1, CD95, FAS1, FASTM}, LPA (lipoprotein(a)) [NCBI Gene 4018] {aka AK38, APOA, LP}
- **Diseases:** nausea (MESH:D009325), fibrotic lesions (MESH:D009059), Lung adenocarcinomas (MESH:D000077192), respiratory failure (MESH:D012131), lymphadenopathy (MESH:D008206), carcinogenesis (MESH:D063646), pneumonitis (MESH:D011014), functional disability (MESH:D003291), scar (MESH:D002921), MDD (MESH:D003865), genetic abnormalities (MESH:D030342), ATII (MESH:D002282), squamous cell carcinoma (MESH:D002294), FibrOSIS (MESH:D005355), disease (MESH:D004194), tobacco (MESH:D014029), injury (MESH:D014947), chronic inflammation (MESH:D007249), large cell lung cancer (MESH:D055752), fibrotic lung (MESH:D008171), Cancer (MESH:D009369), adenocarcinoma (MESH:D000230), DIAgnosis (MESH:D001523), Lung cancer (MESH:D008175), emphysema (MESH:D004646), lung function decline (MESH:D055370), liver cirrhosis (MESH:D008103), pulmonary fibrosis (MESH:D011658), telomere dysfunction (MESH:C536801), ILD (MESH:D017563), hepatocellular carcinoma (MESH:D006528), infectious diseases (MESH:D003141), epithelial injury (MESH:D009375), metastasis (MESH:D009362), tumorigenic (MESH:D002471), death (MESH:D003643), mucinous (MESH:D002288), IPF (MESH:D054990), infections (MESH:D007239), leak (MESH:D019559), type II (MESH:D006938), cytotoxic (MESH:D064420)
- **Chemicals:** bleomycin (MESH:D001761), platinum (MESH:D010984), oxygen (MESH:D010100), lipid (MESH:D008055), docetaxel (MESH:D000077143), nintedanib (MESH:C530716), pemetrexed (MESH:D000068437), carboplatin (MESH:D016190), pirfenidone (MESH:C093844), etoposide (MESH:D005047)
- **Species:** Homo sapiens (human, species) [taxon 9606]
- **Mutations:** rs35705950, rs2736100, p. Trp211Arg, G12C
- **Cell lines:** alveolar type II — Canis lupus familiaris (Dog), Spontaneously immortalized cell line (CVCL_0424)

## Figures

2 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12941835/full.md

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Source: https://tomesphere.com/paper/PMC12941835