Improved treatment outcome of pembrolizumab in patients with nonsmall cell lung cancer and chronic obstructive pulmonary disease

Abstract

Emerging immune profiling data suggest a higher sensitivity to immune checkpoint inhibitors (ICIs) in nonsmall cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD), compared to those without COPD. This study aimed to investigate the clinical impact of COPD on the treatment response to ICIs in a large number of patients with NSCLC. In total, 133 patients with spirometry test results were retrospectively identified among those who received palliative pembrolizumab for NSCLC. COPD was defined as pre‐bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.7. Overall survival (OS), progression‐free survival (PFS), and objective response rate were analyzed according to the presence of COPD. Spirometry‐based COPD was present in 59 (44%) patients. Patients with COPD had better OS (hazard ratio [HR] for death, 0.45; 95% confidence interval [CI], 0.26–0.78) and PFS (HR for disease progression or death, 0.50; 95% CI, 0.31–0.79) than those without COPD. These associations persisted after adjusting for potential confounders including smoking history. The response rate was also higher in patients with COPD than in those without COPD (38.2% vs. 20.5%, p = 0.028). Spirometry‐defined COPD was associated with a significantly longer OS and PFS in patients with NSCLC treated with palliative pembrolizumab. Identifying coexisting COPD could predict favorable treatment outcomes in patients with NSCLC treated with pembrolizumab.

Impact of chronic obstructive pulmonary disease on immune checkpoint inhibitor efficacy in advanced lung cancer and the potential prognostic factors

“…In the present study of patients with advanced-stage lung cancer who received ICI therapy, the presence of COPD was significantly associated with longer PFS, which is in accordance with previous studies (9,22,23). The subgroup analysis revealed that moderate and severe COPD tended to have a better impact on the survival of these patients, though these differences did not reach significance.…”

<p>Impact Of Underlying Pulmonary Diseases On Treatment Outcomes In Early-Stage Non-Small Cell Lung Cancer Treated With Definitive Radiotherapy</p>

“…With rapid advancement in immune-oncology, immune checkpoint inhibitors (ICIs) have shown promising results and are now considered as standard of care in advanced NSCLC 31,32. In particular, the presence of COPD is associated with better survival outcomes in patients with advanced NSCLC treated with ICIs 33. Of note, recent studies demonstrated that combining immunotherapy and radiotherapy may improve the outcome of oligometastatic or advanced lung cancer with tolerable side effects 34,35.…”

Coexistence of Emphysema With Non-small-cell Lung Cancer Predicts the Therapeutic Efficacy of Immune Checkpoint Inhibitors

“…Previous studies revealed that current or former smokers with NSCLC are more likely to respond to ICI therapy (2,3). Recently, it was reported that the presence of COPD was associated with longer progression-free survival (PFS) in patients with NSCLC treated with ICIs (11)(12)(13).…”