The dawn of precision medicine in fibrotic interstitial lung disease.

Abstract

Topic importance: Interstitial lung diseases (ILDs) represent a broad group of heterogeneous parenchymal lung diseases. Some ILDs progress, causing architectural distortion and pulmonary fibrosis, thus are called fibrotic ILDs. Recent studies have shown a beneficial effect of antifibrotic therapy in fibrotic ILDs other than Idiopathic Pulmonary Fibrosis (IPF) that manifest progressive pulmonary fibrosis (PPF). However, it is still challenging to predict which patients with fibrotic ILDs will manifest PPF. Precision medicine approaches could identify patients at risk for progression and guide treatment in patients with IPF or PPF.

Review findings: Multiple biomarkers able to highlight disease susceptibility risk, provide an accurate diagnosis, prognosticate or assess treatment response have been identified. Advances in precision medicine led to the identification of endotypes that could discriminate patients with different fibrotic ILDs or patients with different disease course. Importantly, recent studies have shown that particular compounds were efficacious only in particular endotypes. The aforementioned findings are promising. However, implementation in clinical practice is still an unmet need.

Summary: Substantial progress has been observed in the context of precision medicine approaches in fibrotic ILDs during the last years. Nonetheless, there are still infrastructure, financial, regulatory and ethical challenges to overcome for the implementation of precision medicine in the clinical practice. Overcoming such barriers and moving from ''one-size fits all'' approach to a patient-centered care could substantially improve patient's quality of life and survival.