Impact of COPD in patients with lung cancer and advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors

Abstract

While it is relatively well known that the prognosis of patients with lung cancer (LC) treated with surgery is worse in the presence of chronic obstructive pulmonary disease (COPD), it is unknown if this assessment can be extrapolated to patients with advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors. The aim of our study is to analyze the clinical characteristics and survival rates in patients with LC and COPD, and to compare these to the patients without airflow obstruction. From 471 evaluable patients, 324 (69%) were not treated with surgery due to disseminated disease (stages 3B and 4). Of them, 47.7% also had COPD. All patients were treated at the moment of diagnosis according to National Comprehensive Cancer Network guidelines with platinum-based chemotherapy or tyrosine kinase inhibitors. Kaplan–Meier curves showed no significant differences in overall survival between COPD and non-COPD patients (log–rank P=0.65). In the multivariate Cox proportional hazard model adjusting for the most relevant variables, the adjusted hazard ratio (HRadj) was statistically significant for performance status (HRadj =1.33, 95% confidence interval [CI]: 1.11–1.59; P=0.002) and clinical stage (HRadj =0.67, 95% CI: 0.50–0.89; P=0.006), but not for COPD status (HRadj =1.20, 95% CI: 0.83–1.50; P=0.46). Our conclusion is that at present, when using standard care in advanced LC (stages 3B and 4), COPD does not have a significant deleterious impact on overall survival.

Prognostic significance of CT-emphysema score in patients with advanced squamous cell lung cancer

“…This finding is consistent with previous studies, which also found COPD had no prognostic impact in patients with earlystage NSCLC or in patients with advanced NSCLC that received chemotherapy (10,19). In addition, the severity of emphysema in the present study was not well correlated with FEV 1 (%), which was also reported by Ueda et al (10).…”

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

“…Zhai and colleagues found that coexisting COPD was associated with worse survival in patients with early-stage NSCLC undergoing surgical resection [110]. However, this association was insignificant in the study by Izquierdo and colleagues [112], who targeted patients with advanced lung cancer (stage IIIB/IV) treated with chemotherapy. In terms of COPD grade, there was a more apparent decrease in survival for patients with severe COPD, but not for those with mild-to-moderate COPD, as compared to non-COPD patients following lung cancer resection [78, 116].…”

Impact of coexistent chronic obstructive pulmonary disease on the survival of patients with small cell lung cancer receiving chemotherapy

“…Coexisting COPD is a poor prognostic factor for NSCLC, especially in men with squamous cell carcinoma even in never‐smokers . By contrast, other studies have reported that coexisting COPD does not affect the survival of NSCLC patients . However, there are limited data regarding the interaction between small cell lung cancer (SCLC) and COPD, mainly because the prevalence of SCLC is lower than that of other histological lung cancers, such as squamous cell carcinoma and adenocarcinoma .…”