Impact of chemotherapy in the prognosis of non-small-cell lung cancer patients with severe to very severe COPD

Abstract

BackgroundThe aim of the study was to investigate if first-line chemotherapy improves total survival time in non-small-cell lung cancer (NSCLC) patients complicated with severe to very severe COPD.Materials and methodsThis retrospective observational clinical study included 267 consecutive NSCLC patients with COPD complications at the Department of Respiratory and Critical Care Medicine of Tianjin Chest Hospital between January 2009 and January 2018. Sixty-nine evaluable patients were included. The clinical characteristics, toxicity profile, objective response rate, and prognosis were analyzed and compared between patients receiving and those not receiving chemotherapy.ResultsForty-five and 24 patients received first-line chemotherapy plus supportive care and supportive care alone, respectively. Kaplan–Meier curves showed that patients receiving chemotherapy had a statistically significant 6-month longer median overall survival (OS) than that of patients receiving supportive care alone (14.0, 95% CI: 8.5–19.5 vs 8.0, 95% CI: 6.4–9.6, respectively) (chi2=8.857, P=0.003). In the multivariate Cox proportional hazard model adjusted for the most relevant variables, the adjusted hazard ratio (HRadj) differed significantly for the receipt of chemotherapy (HRadj=0.4464, 95% CI: 0.2495–0.7988; P=0.0066) but not for gender (HRadj=0.8527, 95% CI: 0.4461–1.6298; P=0.6297), age (HRadj=1.0021, 95% CI: 0.9609–1.0451; P=0.9214), histology (HRadj=1.4422, 95% CI: 0.6959–2.9889; P=0.3247), cancer stage (HRadj=1.9098, 95% CI: 0.8607–4.2375; P=0.1116), performance status score (HRadj=1.5155, 95% CI: 0.7523–3.0529; P=0.2446), lung function (HRadj=1.3856, 95% CI: 0.7149–2.6857; P=0.3341), or respiratory symptoms (HRadj=1.0518, 95% CI: 0.6032–1.8342; P=0.8586). Patients with grade 3/4 adverse reactions accounted for 29% (13/45) of the chemotherapy group.ConclusionThe results indicated that chemotherapy may improve the OS of NSCLC patients with severe to very severe COPD.

Pulmonary function is implicated in the prognosis of metastatic non-small cell lung cancer but not in extended disease small cell lung cancer

“…Whether the observed difference in survival was attributable to death resulting from pulmonary complications was examined, but the proportion of patients who died due to pulmonary complications was not significantly different between the COPD and non-COPD groups in NSCLC patients given chemotherapy (P=0.14, data not shown), suggesting compromised lung function is not the only medical problem to be taken care of during treatment with chemotherapy. A previous study on treatment outcomes for NSCLC patients with COPD who received chemotherapy reported positive effects of chemotherapy compared with supportive care (8,29), but results from our study indicated that COPD classified as GOLD 2 or worse had an unfavorable impact on treatment of chemotherapy. A previous study reported that the OS of patients with NSCLC who have an effective host DNA repair system is significantly worse than that of NSCLC patients with a suboptimal DNA repair system in conjunction with chemotherapy treatment (30).…”

Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Population-Based Cohort Study

“…Our study is the first study to estimate the survival impact of COPD (Figure 1) and its severity (measured as number of hospitalizations) before the diagnosis of rectal adenocarcinoma in patients with rectal adenocarcinoma (Figure 2). The reason for this association may be that COPD, especially severe COPD, can increase the risk of more intolerable cardiotoxicity or treatment-related toxicity, decrease the cancer-treatment completion rate, or cause more major complications after treatment [21][22][23]68,69]. Another possible explanation is that smoking may cause more aggressive rectal adenocarcinoma [2], and active and heavy smoking is more common among COPDAE phenotypes [70].…”

Treatment Strategies for Non-Small-Cell Lung Cancer with Comorbid Respiratory Disease; Interstitial Pneumonia, Chronic Obstructive Pulmonary Disease, and Tuberculosis

“…Patients with severe COPD requiring home oxygen therapy have been excluded from many clinical trials and studies, and there are few reports on chemotherapy for LC. However, a retrospective observational study has reported that even advanced NSCLC patients with severe to most severe COPD had a longer OS with chemotherapy than with supportive care alone (14.0 vs. 8.0 months, p = 0.003) [65]. The Japanese retrospective study evaluating the efficacy and safety of chemotherapy in 40 patients with advanced LC complicated by chronic respiratory failure requiring home oxygen therapy also showed that the only factor significantly associated with improved prognosis was the use of first-line or second-line treatment (HR, 0.42; 95% CI: 0.18-0.94) [66].…”