Effect of Perioperative Pirfenidone Treatment in Lung Cancer Patients With Idiopathic Pulmonary Fibrosis

Iwata, Takekazu; Yoshida, Shigetoshi; Fujiwara, Taiki; Wada, Hironobu; Nakajima, Takahiro; Suzuki, Hidemi; Yoshino, Ichiro

doi:10.1016/j.athoracsur.2016.05.094

Cited by 74 publications

(51 citation statements)

References 27 publications

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“…Pirfenidone has been shown to reduce the frequency of AE‐IPF in large randomized controlled trials . In line with our observation, a prophylactic effect of pirfenidone for postoperative AE‐IPF in patients with lung cancer undergoing surgery was suggested . Attenuation of the injury to the native lung might be a possible explanation for the effect we observed.…”

Section: Discussionsupporting

confidence: 88%

Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation

Veit

Leuschner

Sisic³

et al. 2019

American Journal of Transplantation

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Pirfenidone demonstrated pleiotropic antiinflammatory effects in various experimental and clinical settings. The aim of this study was to assess the impact of previous treatment with pirfenidone on short-term outcomes after single lung transplantation (SLTx). Therefore, patients with idiopathic pulmonary fibrosis (IPF) who were undergoing SLTx were screened retrospectively for previous use of pirfenidone and compared to respective controls. Baseline parameters and short-term outcomes were recorded and analyzed. In total, 17 patients with pirfenidone were compared with 26 patients without antifibrotic treatment. Baseline characteristics and severity of disease did not differ between groups. Use of pirfenidone did not increase blood loss, wound-healing, or anastomotic complications. Severity of primary graft dysfunction at 72 hours was less (0.3 ± 0.6 vs 1.4 ± 1.3, P = .002), and length of mechanical ventilation (37.5 ± 34.8 vs 118.5 ± 151.0 hours, P = .016) and intensive care unit (ICU) stay (6.6 ± 7.1 vs 15.6 ± 20.3, P = .089) were shorter in patients with pirfenidone treatment. An independent beneficial effect of pirfenidone was confirmed by regression analysis while controlling for confounding variables (P = .016). Finally, incidence of acute cellular rejections within the first 30 days after SLTx was lower in patients with previous pirfenidone treatment (0.0% vs 19.2%; P = .040). Our data suggest a beneficial role of previous use of pirfenidone in patients with IPF who were undergoing SLTx. K E Y W O R D Sclinical research/practice, critical care/intensive care management, lung (allograft) function/ dysfunction, lung (native) function/dysfunction, lung disease, lung transplantation/ pulmonology, organ transplantation in general

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Section: Discussionsupporting

confidence: 88%

Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation

Veit

Leuschner

Sisic³

et al. 2019

American Journal of Transplantation

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“…Prediction of postoperative complications and long-term disability caused by pulmonary resection requires preoperative physiologic rehabilitation or treatment, to reduce a risk of respiratory failure for lung cancer patients with underlying pulmonary diseases such as idiopathic pulmonary fibrosis (IPF) [26] or chronic obstructive disease [27]. Planned surgical invasiveness as indicated by surgical approach, volume of resected lung, extent of nodal dissection, and extensive resection can have major physiological impacts on postoperative respiratory function in these patients.…”

Section: Prevention Of Rfmentioning

confidence: 99%

Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Endo

Ikeda

Kondo

et al. 2018

Gen Thorac Cardiovasc Surg

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Background Broncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. Risk assessments for BPF and RF in addition to mortality and major morbidities are indispensable in surgical decision-making and perioperative care. Methods The characteristics and operative data of 80,095 patients who had undergone lung cancer surgery were derived from the 2014 and 2015 National Clinical Database (NCD) of Japan datasets. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset. Receiver operating characteristic curves were generated for postoperative BPF and RF development. The concordance-index was used to assess the discriminatory ability and validity of the model. Results BPF and RF occurred in 259 (0.3%) and 420 patients (0.5%), respectively, in the model development dataset and in 129 (0.3%) and 198 patients (0.5%), respectively, in the model validation dataset. Characteristic variables including types of surgery and comorbidities were identified as risk factors for BPF and RF, respectively. The concordance indexes of assessments for BPF and RF were 0.847 (p < 0.001) and 0.848 (p < 0.001), respectively, for the development dataset and 0.850 (p < 0.001) and 0.844 (p < 0.001), respectively, for the validation dataset. Conclusions These models are satisfactory for predicting BPF and RF after lung cancer surgery in Japan and could guide preoperative assessment and optimal measures for preventing BPF and RF.

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“…Oral pirfenidone, a pyridone compound with pleiotropic effects, exhibited antioxidant, anti-inflammatory, and antifibrotic effects in experimental models of pulmonary fibrosis. Pirfenidone might lower levels of factors associated with proliferation, such as transforming growth factor-beta [8]. A phase II study found that pirfenidone limited IPF disease progression and lowered AE-IPF incidence after lung cancer surgery [9].…”

Section: Resultsmentioning

confidence: 99%

Recommendations for perioperative management of lung cancer patients with comorbidities

Tsubochi

Shibano

Endo

2017

Gen Thorac Cardiovasc Surg

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ObjectivesTo improve surgical outcomes, clinicians must provide optimal perioperative care for comorbidities identified as significant factors in risk models for patients undergoing lung cancer surgery.MethodsWe reviewed trends in perioperative care for idiopathic pulmonary fibrosis, cardiovascular diseases, and end-stage renal diseases in patients undergoing lung cancer surgery, as large clinical databases indicate that these comorbidities are significant risk factors for lung cancer surgery. Articles identified by keyword searches were included in the analysis.ResultsSignificant predictive factors for acute exacerbation of idiopathic pulmonary fibrosis were identified. However, no effective perioperative care was identified for prevention of acute exacerbation of interstitial pneumonia. The timing of coronary revascularization and antithrombotic management for cardiovascular diseases are subjects of ongoing research, and acid–base balance is essential in the management of hemodialysis patients with end-stage renal diseases.ConclusionsTo improve surgical outcomes for lung cancer patients, future studies should continue to study optimal perioperative management of comorbidities.

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Effect of Perioperative Pirfenidone Treatment in Lung Cancer Patients With Idiopathic Pulmonary Fibrosis

Cited by 74 publications

References 27 publications

Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation

Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation

Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Recommendations for perioperative management of lung cancer patients with comorbidities

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