Neoadjuvant immunology therapy in patients with non-small cell lung cancer and chronic obstructive pulmonary disease.

Background: For patients with early non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD), the efficacy and safety of immunotherapy are still unclear. This study was designed to investigate the effect and safety of neoadjuvant immunotherapy for patients with resectable NSCLC including those with coexisting COPD and the effect on patients' lung function.

Methods: Data of patients with resectable NSCLC who received neoadjuvant immunotherapy at the Shanghai Chest Hospital were retrospectively analyzed.

Results: A total of 57 patients were enrolled and 18 of those were with coexisting COPD. For COPD patients, the objective response rate (ORR), major pathological response (MPR), and pathological complete response (pCR) were 44.4%, 55.6%, and 38.9%, respectively, which were not statistically different from those of non-COPD patients. The 2-year event-free survival (EFS) and overall survival (OS) rates were 73.7% and 88.5%, respectively, which were lower than those of patients without COPD, but the difference was not statistically significant. After neoadjuvant immunotherapy, the ratio of forced expiratory volume in 1 second (FEV1), the ratio of FEV1 to the predicted value (FEV1%pred), forced vital capacity (FVC), and the ratio of FVC to the predicted value (FVC%pred) all improved, however, carbon monoxide diffusing capacity (DLCO) and DLCO adjusted by hemoglobin (DLCOc) were lower. For patients with COPD, only FEV1 improved after immunotherapy.

Conclusions: For resectable NSCLC patients with COPD, neoadjuvant immunotherapy could achieve better pathological response, survival benefit and improve patients' lung function.