IPF and lung cancer. Retrospective analysis of antifibrotic drugs and thoracic surgery.

<bold>Background</bold>- The prognosis of patients with IPF may be significantly worsened by the association with lung cancer. Surgical treatment is the elective choice for early cancer associated with ILD, although it may lead to an increased risk of exacerbations. Background therapy with antifibrotic drugs (AF) Pirfenidone and Nintedanib - has been shown to reduce the frequency of these exacerbations. <bold>Methods/Aim</bold>- We analysed a cohort of patients admitted to Careggi University Hospital from 2018 to 2024 aiming to evaluate the efficacy of AF. The diagnosis of IPF, the indication for AF treatment and the timing of therapy relating to surgery is made in a multidisciplinary setting. Diagnosis and staging were performed by cryoprobe/EBUS or VATS as appropriate. Patients had pre- and postoperative pulmonary function tests and clinical-radiological follow-up(FU). The AF was discontinued 1 week before surgery. <bold>Results</bold>- We collected 18 patients (12 males , 66%), median age 79.50 yr [58-82]. Mean FVC 99.44% ± 15.73, mean DLCO 59.72% ±12.01. 78%(14) of patients treated with Pirfenidone, the rest with Nintedanib. In 3/18 cases simultaneous IPF diagnosis and tumour staging were performed by combined cryobiopsy and EBUS. Surgery consisted of lobectomy/atypical resection +lymphadenectomy(89%) or segmentectomy(11%). We completed 1-yr-FU in 15 patients: all of them survived , no one showed radiological progression of IPF, 3 had functional progression (FVC/DLCO drop >10% or need for oxygen therapy). 3/18 cases FU is not completed <bold>Conclusion</bold>- Our study highlights the cruciality of a multidisciplinary approach in managing patients with cancer and IPF, confirming AF's protective efficacy against post-surgical exacerbations.