Impact of COPD on prognosis of lung cancer: the prespective of immunotherapy treatment

Introduction: Due to its persistent inflammatory state, chronic obstructive pulmonary disease (COPD) has been shown to alter intratumoral microenvironment in non-small cell lung cancer (NSCLC), increasing immune checkpoint expression. However, how this finding influences immune checkpoint inhibitors (ICI) response is still poorly understood. Aim: To evaluate the impact of COPD on clinical outcomes of NSCLC patients (pts) under ICI. Methods: Retrospective study of NSCLC pts treated with ICI from September 2015 to December 2019 on an oncology center. COPD was defined according to GOLD criteria. Clinical outcomes included overall survival (OS) and progression-free survival (PFS). Results: 164 pts were included: 112 males (68.3%); median age 62 years (IQR 54.5-68.0); median programmed death ligand 1 (PD-L1) expression of 30% (IQR 0-60); 31.7% received ICI as first-line therapy. During follow-up, median time 13 months (IQR 5.0-24.5), 67.1% had disease progression and 68.9% died. COPD was present in 40.2% (68.2% GOLD 2): mainly man (p=0.043), current smokers (p=0.035) and older age (p=0.038) compared to non-COPD pts. No differences were found in histological subtype, disease stage, PD-L1 expression and ICI related toxicity between COPD and non-COPD pts. There was also no statistically significant difference in Kaplan-Meier analysis for OS (13.5 vs. 13 months, log-rank p= 0.692) and PFS (6.0 vs. 5.5 months, log-rank p= 0.664) of COPD vs. non-COPD pts. Conclusion: Although previous findings showed increased immune checkpoint expression and PFS in pts with COPD, in our study, this diagnosis was not associated with improved clinical outcomes in NSCLC treated with ICI.