Experience with perioperative pirfenidone for lung cancer surgery in patients with idiopathic pulmonary fibrosis

• Published in: Surgery today (Tokyo, Japan) Vol. 45; no. 10; pp. 1263 - 1270
• Main Authors: Iwata, Takekazu, Yoshida, Shigetoshi, Nagato, Kaoru, Nakajima, Takahiro, Suzuki, Hidemi, Tagawa, Tetsuzo, Mizobuchi, Teruaki, Ota, Satoshi, Nakatani, Yukio, Yoshino, Ichiro
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.10.2015
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Antifibrinolytic Agents - administration & dosage; Disease Progression; Feasibility Studies; Female; Humans; Idiopathic Pulmonary Fibrosis - complications; Idiopathic Pulmonary Fibrosis - prevention & control; Idiopathic Pulmonary Fibrosis - surgery; Lung Neoplasms - complications; Lung Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Perioperative Care; Postoperative Complications - prevention & control; Pyridones - administration & dosage; Retrospective Studies; Surgery; Surgical Oncology; Treatment Outcome; Acute exacerbation; Pirfenidone; Idiopathic pulmonary fibrosis; Lung cancer; Surgery
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-014-1071-5

Purpose Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse lung disease associated with an increased risk of lung cancer. Patients with IPF sometimes develop a life-threatening acute exacerbation of IPF (AE-IPF) after lung cancer surgery. In this retrospective study, pirfenidone, an antifibrotic agent, was perioperatively administered to IPF patients with lung cancer with the aim of preventing postoperative AE-IPF, and the feasibility and clinical outcomes were investigated. Methods Twelve IPF patients with concomitant lung cancer who received perioperative pirfenidone treatment (PPT) for lung cancer surgery were retrospectively investigated. Sixteen IPF patients undergoing lung cancer surgery without PPT were analyzed as historical controls. Results Compared to the controls, the PPT patients had a more severely impaired preoperative pulmonary function and a larger number of limited pulmonary resections. There was a significant preoperative decrease in the serum KL-6 levels of the PPT patients. No severe pirfenidone-related complications or IPF-related events occurred in the PPT patients, while six control patients developed AE-IPF ( P  = 0.0167). A quantitative histopathological evaluation of resected lung specimens found that tissue changes associated with IPF were significantly fewer in the PPT patients ( P  = 0.021). Conclusions PPT is a feasible perioperative treatment for IPF patients with lung cancer. Its effectiveness in preventing postoperative AE-IPF thus warrants prospective verification.