Journal club

Abstract

Patients with idiopathic pulmonary fibrosis (IPF) are at increased risk of developing lung cancer, and the coexistence of these diseases is associated with significantly worse overall survival compared with either condition alone. This is partly due to the clinical conundrums posed by IPF, as impaired lung function may preclude curative surgical resection, and other treatments can precipitate acute exacerbations in IPF. Pirfenidone has a well-established role in slowing the progressive decline in forced vital capacity (FVC), with small studies highlighting that it may also reduce the risk of lung cancer. Yoon and colleagues (ERJ 2025;65(2):2401484) conducted a retrospective study mining South Korea’s national health insurance database, identifying a cohort of 10 084 patients with IPF. By applying inverse probability treatment weighting to balance covariates between the two retrospective groups, they demonstrated that the incidence rate of lung cancer was 10.4 cases per 1000 person years in patients receiving pirfenidone compared with 27.9 cases per 1000 person years in patients not taking pirfenidone. These findings were validated in a clinical cohort where detailed case note review ensured accurate phenotyping of IPF. In this cohort, pirfenidone use was associated with a reduced risk of lung cancer development, with a weighted adjusted HR of …