Immune checkpoint inhibitors for advanced non-small cell lung cancer with preexisting COPD and CT-defined emphysema:
Yixiao Zhang1, Jin Zhao1, Zhuo Ma2
1Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Background:
Preexisting chronic obstructive pulmonary disease(COPD) and Computed Tomography(CT)-defined emphysema are associated with worse prognosis in patients with non-small cell lung cancer(NSCLC) receiving chemotherapy, but the impact of these comorbidities on patients undergoing immune checkpoint inhibitors(ICIs) remains largely unclear.
Methods:
Studies on the safety and efficacy outcomes among advanced NSCLC with preexisting COPD and CT-defined emphysema receiving ICIs from various databases up to August 2024 were collected. The number of events, as well as pooled effect size [odds ratio(OR) and hazard ratio (HR)] and 95% confidence intervals (CIs) were obtained.
Results:
A total of 21 studies (7 on efficacy, 11 on safety, and 3 on both) were included. Meta-analysis revealed the pooled overall response rate (ORR) and pooled disease control rate (DCR) were 38% and 62%, respectively. Compared to patients without preexisting COPD and CT-defined emphysema, the pooled OR for ORR and DCR was 1.88 (95% CI, 1.45-2.44) and 2.23 (95% CI, 1.67-2.98), without heterogeneity. COPD and CT-defined emphysema were also associated with better progression-free survival (HR, 0.63 [95% CI, 0.50-0.80]) and overall survival (HR, 0.59 [95% CI, 0.41-0.88]). The pooled incidences of any grade and grade 3 or higher checkpoint inhibitor-related pneumonitis (CIP) were 20% and 6% in patients with preexisting COPD and CT-defined emphysema, which was significantly higher than that in those without these comorbidities (OR, 1.97 [95% CI, 1.41-2.76]; OR, 2.52 [95% CI, 1.72-3.70]). Moreover, most cases of CIP (84.0%) improved with ICIs discontinuation and/or the administration of corticosteroids.
Conclusion:
Preexisting COPD and CT-defined emphysema were associated with favorable clinical efficacy and increased risk of CIP in the immunotherapy era. Most cases of CIP are treatable and manageable.
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