COPD Associated With Poorer Survival in Advanced NSCLC: Study
Japan: Among ever-smokers with advanced non-small cell lung cancer receiving first-line immune checkpoint inhibitor plus chemotherapy, COPD was associated with poorer survival. Further validation in larger, prospective cohorts is needed to confirm these findings.
The findings are from a study published in BMC Pulmonary Medicine by Akihisa Takano from the Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and colleagues.
Chronic obstructive pulmonary disease (COPD) commonly coexists with non-small cell lung cancer (NSCLC), largely because both conditions share cigarette smoking as a major risk factor. While previous research has suggested that COPD may improve outcomes in patients treated with immune checkpoint inhibitor (ICI) monotherapy, its impact on patients receiving the now-standard combination of immunotherapy and chemotherapy has remained uncertain.
To investigate this, the researchers conducted a retrospective single-center study involving 55 ever-smokers with stage IV NSCLC who received first-line ICI plus chemotherapy and had undergone pulmonary function testing. COPD was diagnosed using a post-bronchodilator FEV1/FVC ratio below 0.70. Thirty-three patients were classified as having COPD, while 22 did not have the condition.
The researchers evaluated progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier analyses and Cox proportional hazards models. To minimize differences between the two groups, they also performed inverse probability of treatment weighting (IPTW) based on propensity scores.
Key findings
- Before adjustment, median progression-free survival was 5.3 months in patients with COPD compared with 11.1 months in those without COPD.
- After IPTW adjustment, progression-free survival remained significantly shorter in the COPD group (4.6 months vs. 13.7 months).
- Before adjustment, median overall survival was 12.7 months in patients with COPD, while it was not reached in the non-COPD group.
- After IPTW adjustment, overall survival remained significantly poorer in patients with COPD (11.8 months vs. not reached).
- COPD was independently associated with a significantly higher risk of disease progression and death after adjustment for baseline differences.
The findings contrast with earlier reports suggesting that COPD may enhance responses to immune checkpoint inhibitor monotherapy. According to the researchers, the addition of chemotherapy may alter the interaction between COPD-related airway inflammation and the immune response, potentially influencing treatment outcomes differently.
The authors acknowledged several limitations. The retrospective, single-center study included a small sample size, limiting generalizability. Restricting the analysis to ever-smokers who underwent pulmonary function testing may have introduced selection bias, and residual confounding from unmeasured factors cannot be ruled out despite statistical adjustment.
The researchers concluded that COPD may be an important prognostic factor in ever-smokers with advanced NSCLC treated with first-line immune checkpoint inhibitor plus chemotherapy. They emphasized the need for larger prospective studies to validate these findings and to better understand how COPD influences treatment response and survival in this patient population.
Reference:
Takano, A., Shibahara, D., Ogata, H. et al. COPD is associated with poorer survival in patients with advanced non-small cell lung cancer treated with first-line ICI plus chemotherapy. BMC Pulm Med (2026). https://doi.org/10.1186/s12890-026-04509-3
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