Do inhaled corticosteroids protect against lung cancer in patients with COPD? A systematic review

Abstract

Inhaled corticosteroids (ICS) are commonly prescribed to COPD patients, particularly those with more advanced stages of the disease. These patients are also at increased risk of lung cancer. A systematic review was undertaken to identify studies that examined the association between lung cancer risk and ICS therapy in COPD patients. The search strategy was created in MEDLINE and extended to EMBASE as well as other relevant databases. Both randomized controlled trials (RCTs) and observational studies were considered for inclusion. Studies were required to have incident lung cancer or deaths from lung cancer as an outcome in order to be included in the review. Six studies met the inclusion criteria. Two observational studies directly addressed the specific research. Four RCTs presented sufficient data to calculate the relative risk of lung cancer in COPD patients. None of the identified RCTs showed a statistically significant association of ICS use with lung cancer risk. Observational studies showed a protective effect from ICS use, particularly at high doses. Given the observational evidence and the low numbers of lung cancer events in the RCTs, these results may be prone to type II error. The observational studies dealt with very specific patient populations and exposure definitions, which might not have adequately captured the complex relationship between ICS exposure and lung cancer risk. Results from RCTs suggest no effect of ICS on the risk of lung cancer. However, results from observational studies suggest the potential that ICS may confer a protective effect, particularly at high doses.

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

“…Inhaled corticosteroids (ICS), which are commonly prescribed to COPD patients, are now showing a potential cancer prevention effect [31]. A nested case-control study of patients with COPD demonstrated that regular use of ICS was significantly associated with a decreased lung cancer risk [32].…”

Inhaled corticosteroids have a protective effect against lung cancer in female patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study

“…Their analysis of randomized controlled trials (RCTs) showed no statistically significant association between ICS use and lung cancer risk, whereas observational studies showed a protective effect of ICS use, particularly at higher doses and with more frequent use [27]. The primary objective of these RCTs was not to examine the protective effects of ICS on lung cancer, but the efficacy of ICS use in COPD.…”

“…Another prospective observational study demonstrated that a high ICS dose is correlated with a decreased risk of lung cancer [20]. However, there are many conflicting ideas in the literature about the role of ICS in the prevention of lung cancer [20–27]. Taiwan's National Health Insurance (NHI) database may provide a larger population and longer follow-up interval data than previous studies.…”

Year in review 2017: Chronic obstructive pulmonary disease and asthma

“…This approach is also advocated by the GOLD 2017 report and discussed in an editorial by Calverley . A systematic review of the impact of inhaled corticosteroid treatment on the risk of lung cancer in COPD by Raymakers et al . found that randomized studies demonstrated no evidence of benefit, although descriptive studies showed some protection at high doses.…”

“…This approach is also advocated by the GOLD 2017 report and discussed in an editorial by Calverley. 16,31 A systematic review of the impact of inhaled corticosteroid treatment on the risk of lung cancer in COPD by Raymakers et al 32 found that randomized studies demonstrated no evidence of benefit, although descriptive studies showed some protection at high doses. Finally, a prospective cohort study by Shin et al 4 reported post-operative respiratory complications in nearly 25% of COPD patients following extra-pulmonary surgery.…”