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Volume 13
Issue 9
10.3390/biomedicines13092310
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Article

The Role of Antifibrotic Therapy in Pulmonary Fibrosis and Lung Cancer: A Multicenter Retrospective Analysis

by
Francesco Rocco Bertuccio
1,2,
Nicola Baio
3,
Fabio Perrotta
4,
Donato Lacedonia
5,6,
Vito D’Agnano
4,
Andrea Bianco
4,
Giulia Scioscia
5,6,
Pasquale Tondo
5,6,
Maria Pia Foschino Barbaro
5,6,
Chandra Bortolotto
7,8,
Angelo Guido Corsico
1,2 and
Giulia Maria Stella
1,2,*
1
Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy
2
Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, 27100 Pavia, Italy
3
Ospedale Maggiore, Unit of Pneumology, Azienda Socio-Sanitaria Territoriale (ASST) Crema, 26013 Crema, Italy
4
Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80100 Napoli, Italy
5
Department of Medical and Surgical Sciences, University of Foggia, 71121 Foggia, Italy
6
Department of Specialist Medicine, Institute of Respiratory Diseases, University-Hospital Polyclinic “Riuniti”, 71121 Foggia, Italy
7
Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia Medical School, 27100 Pavia, Italy
8
Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, 27100 Pavia, Italy
*
Author to whom correspondence should be addressed.
Biomedicines 2025, 13(9), 2310; https://doi.org/10.3390/biomedicines13092310
Submission received: 23 August 2025 / Revised: 10 September 2025 / Accepted: 18 September 2025 / Published: 21 September 2025
(This article belongs to the Special Issue Thoracic Malignancies: From Pathophysiology to Novel Therapeutic Approaches)
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Abstract

Background: Patients with fibrotic interstitial lung disease (ILD) are at increased risk of lung cancer, yet the impact of antifibrotic therapy on oncologic outcomes remains unclear. Objective: This study aimed to explore associations between antifibrotic therapy and overall survival (OS) and acute exacerbations of ILD (AE-ILD) in patients with fibrotic ILD who develop lung cancer. Methods: We retrospectively analyzed 61 patients from multiple Italian centers: 35 received antifibrotic therapy (pirfenidone or nintedanib) and 26 did not. Outcomes included OS from cancer diagnosis and post-treatment AE-ILD. Results: Mean OS was 17.9 months in the antifibrotic group and 33.2 months in the non-antifibrotic group; no adjusted survival analyses were possible due to missing censoring data, and these descriptive values should not be overinterpreted. AE-ILD occurred in 11.4% of antifibrotic-treated patients and 11.5% of those without antifibrotics. PD-L1 expression was detected in 24.1% vs. 21.8% of tumors in the two groups, and autoantibody positivity was observed in 22.8% vs. 30.7%, respectively, reflecting differences in ILD subtypes. Conclusions: In this heterogeneous real-world cohort, antifibrotic therapy was not associated with increased AE-ILD risk, and descriptive OS comparisons showed no clear survival advantage. These exploratory findings warrant confirmation in larger, prospective studies.
Keywords: pulmonary fibrosis; interstitial lung disease; lung cancer; antifibrotics; nintedanib; pirfenidone; acute exacerbation; PD-L1; immunotherapy pulmonary fibrosis; interstitial lung disease; lung cancer; antifibrotics; nintedanib; pirfenidone; acute exacerbation; PD-L1; immunotherapy

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MDPI and ACS Style

Bertuccio, F.R.; Baio, N.; Perrotta, F.; Lacedonia, D.; D’Agnano, V.; Bianco, A.; Scioscia, G.; Tondo, P.; Foschino Barbaro, M.P.; Bortolotto, C.; et al. The Role of Antifibrotic Therapy in Pulmonary Fibrosis and Lung Cancer: A Multicenter Retrospective Analysis. Biomedicines 2025, 13, 2310. https://doi.org/10.3390/biomedicines13092310

AMA Style

Bertuccio FR, Baio N, Perrotta F, Lacedonia D, D’Agnano V, Bianco A, Scioscia G, Tondo P, Foschino Barbaro MP, Bortolotto C, et al. The Role of Antifibrotic Therapy in Pulmonary Fibrosis and Lung Cancer: A Multicenter Retrospective Analysis. Biomedicines. 2025; 13(9):2310. https://doi.org/10.3390/biomedicines13092310

Chicago/Turabian Style

Bertuccio, Francesco Rocco, Nicola Baio, Fabio Perrotta, Donato Lacedonia, Vito D’Agnano, Andrea Bianco, Giulia Scioscia, Pasquale Tondo, Maria Pia Foschino Barbaro, Chandra Bortolotto, and et al. 2025. "The Role of Antifibrotic Therapy in Pulmonary Fibrosis and Lung Cancer: A Multicenter Retrospective Analysis" Biomedicines 13, no. 9: 2310. https://doi.org/10.3390/biomedicines13092310

APA Style

Bertuccio, F. R., Baio, N., Perrotta, F., Lacedonia, D., D’Agnano, V., Bianco, A., Scioscia, G., Tondo, P., Foschino Barbaro, M. P., Bortolotto, C., Corsico, A. G., & Stella, G. M. (2025). The Role of Antifibrotic Therapy in Pulmonary Fibrosis and Lung Cancer: A Multicenter Retrospective Analysis. Biomedicines, 13(9), 2310. https://doi.org/10.3390/biomedicines13092310

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