TOPLINE:

In patients with idiopathic pulmonary fibrosis, the use of antifibrotic therapy was associated with a lower incidence rate and risk for lung cancer.

METHODOLOGY:

• Researchers conducted a retrospective study at Mayo Clinic sites in the US to evaluate the association between antifibrotic use and the incidence of lung cancer in patients with idiopathic pulmonary fibrosis.
• They assessed 3313 patients with idiopathic pulmonary fibrosis, including those who received antifibrotic therapy (n = 1161; 73.6% men) and those who did not (n = 2152; 64.8% men).
• Patients were classified according to two diagnostic eras for idiopathic pulmonary fibrosis — the pre-antifibrotic era (2005-2013) and the post-antifibrotic era (2014-2022).
• Antifibrotic treatment was defined as the uninterrupted use of pirfenidone, nintedanib, or both in sequence for ≥ 6 months before a lung cancer diagnosis.

TAKEAWAY:

• The incidence rate of newly diagnosed lung cancer was lower among those who received antifibrotic therapy than among those who did not ( 0.34 vs 1.25 per 100 person-years; P < .001).
• No significant difference was observed in the number of patients with newly diagnosed lung cancer between the pre- and post-antifibrotic eras.
• The use of antifibrotic therapy was an independent predictor of lung cancer development (adjusted subdistribution hazard ratio, 0.36; P = .015); however, neither pirfenidone nor nintedanib alone yielded a statistically significant reduction in the risk for lung cancer.
• Smoking history, pack-years, and forced vital capacity were predictors of lung cancer development in the multivariate analysis (P < .05 for all).

IN PRACTICE:

“Additional prospective patient-level studies are needed to explore specific mitigating pathways and delineate the extent of individual risk reductions for each drug ,” the authors of the study wrote.

SOURCE:

This study was led by Supiya Kijlertsuphasri , Mayo Clinic, Rochester, Minnesota. It was published online on January 21, 2026, in Thorax.

LIMITATIONS:

The 16-year study window encompassed evolving diagnostic and treatment practices that could have affected survival and treatment selection. Temporal shifts — for example, the increased use of high-resolution scans and lower smoking rates — may have altered background lung cancer risk but could not be accounted for in this study.

DISCLOSURES:

The authors did not report any specific funding. They declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.