Effect of chronic obstructive pulmonary disease on immunotherapy in patients with advanced non-small cell lung cancer

To investigate the effects of chronic obstructive pulmonary disease（COPD）on the clinical efficacy and incidence of checkpoint inhibitor pneumonitis（CIP）in patients with advanced non-small cell lung cancer（NSCLC）receiving immune checkpoint inhibitors（ICIs）.

A retrospective cohort study was performed in 379 patients with Ⅲb-Ⅳ NSCLC who received at least 2 times of ICIs treatment in the Second Affiliated Hospital of Army Medical University from January 2019 to August 2021. According to the Global Initiative for Chronic Obstructive Lung Disease（GOLD）2021 and diagnostic criteria of COPD by chest high-resolution CT scans, 184 patients were assigned into NSCLC combined with COPD group（NSCLC-COPD group）and 195 into the simple NSCLC group（NSCLC group）. The efficacy indicators of end points included objective response rate（ORR）, progression free survival（PFS）, overall survival（OS）and incidence of CIP. The effects of COPD on the efficacy of ICIs and incidence of CIP were analyzed in these NSCLC patients.

The ORR was significantly better in the NSCLC-COPD group than the NSCLC group（45.7% vs 35.4%, P=0.042）. Multivariate logistic regression analysis after adjustment for confounding factors showed that complication of COPD was an independent prognostic factor of ORR（HR=0.587, 95%CI: 0.379~0.909, P=0.017）. The median PFS of the NSCLC-COPD group was obviously longer than that of the NSCLC group（14.6 vs 10.9 months, P=0.023）. Multivariate Cox analysis indicated that COPD might be a factor for good prognosis of PFS（HR=0.768, 95%CI: 0.581~1.015, P=0.064）. No significant correlation was observed between COPD and OS. Among the 13 patients with CIP in all these patients, 9 patients（4.9%）were in the NSCLC-COPD group and 4 patients（2.1%）in NSCLC group. There was no statistical difference between the 2 groups（P=0.162）.

ICIs result in better ORR and PFS in NSCLC-COPD patients than those only NSCLC, suggesting that COPD is a potential predictor of better response to ICIs. The presence of COPD does not increase the risk of CIP.