Chemotherapy in NSCLC Patients With COPD: Do Benefits Outweigh the Risks?

The benefits of chemotherapy may outweigh the risks in non–small-cell lung cancer (NSCLC) patients with severe to very severe chronic obstructive pulmonary disease (COPD), found a new study published in the International Journal of Chronic Obstructive Pulmonary Disease.

Researchers conducted a retrospective, observational clinical trial to investigate whether first-line chemotherapy improved overall survival (OS) in NSCLC patients with severe to very severe COPD. The study included 267 consecutive NSCLC patients with COPD complications who were treated between January 2009 and January 2018. A total of 69 patients were evaluable, 45 of whom received first-line chemotherapy plus supportive care, and 24 who received supportive care alone.

Previous studies suggested that mild-to-moderate COPD had no evident adverse impact on the prognosis of patients with NSCLC receiving first-line chemotherapy. However, there was concern about patients with severe to very severe COPD who present with serious cough, dyspnea, sputum, and other respiratory symptoms. Studies suggest that these patients also often have cardiovascular or cerebrovascular complications, raising questions about whether the benefits of chemotherapy outweigh the potential serious adverse effects.

Using Kaplan–Meier curves, the investigators found that patients receiving chemotherapy had a statistically significant 6-month longer median OS compared with patients receiving supportive care alone (14.0 months vs 8.0 months). A multivariate Cox proportional hazard model enabled adjustment for the most relevant variables, revealing that the adjusted hazard ratio (HRadj) differed significantly for the receipt of chemotherapy (HRadj, 0.4464), but not for gender, age, histology, cancer stage, performance status score, lung function, or respiratory symptoms.

Receipt of chemotherapy was generally well tolerated; however, grade 3/4 adverse reactions occurred in 13 of 45 patients in the chemotherapy group (29%). Gastrointestinal (GI) reactions were the most frequently reported adverse responses, affecting 17 of 45 patients (38%); however, only one patient (2%) experienced a serious grade 3 GI reaction. While myelosuppression was a commonly reported adverse drug reaction, the researchers concluded that COPD severity or lung function status may not be important factors with regard to chemotherapy in this patient population. However, they noted, further studies are warranted.

Mark Dransfield, MD, a professor in the UAB Division of Pulmonary, Allergy and Critical Care Medicine and the Medical Director of the UAB Lung Health Center in Birmingham, Alabama, said that although these study findings are intriguing, he recommends utilizing caution in drawing a firm conclusion.

“Since it [the study] was not randomized, there were likely many reasons why patients received chemotherapy versus supportive care,” Dransfield told Cancer Network. “The sickest patients almost certainly were more likely to receive only the latter. This might have made it seem as if chemotherapy was beneficial. That said, some patients with severe to very severe COPD are candidates for chemotherapy or immunotherapy, and the decision should be individualized and not based solely on lung function results,” he said.