COPD and pulmonary emphysema as prognostic factors in patients with non-small cell lung cancer receiving immunotherapy

<bold>Introduction</bold> Chronic obstructive pulmonary disease (COPD) and pulmonary emphysema (PE) are risk factors for lung cancer. They are characterised by an excessive inflammatory response. Immunotherapy (IO) is one of the treatments for advanced stages of non-small cell lung cancer (NSCLC) and it could have better results in an inflammatory milieu, such as COPD and PE. <bold>Objective:</bold> To evaluate if COPD and/or PE are good prognostic factors in patients with advanced NSCLC (stage ≥ IIIa) treated with IO. <bold>Materials & methods</bold> Retrospective study of patients with advanced stage of NSCLC treated with IO (2018-2022). Staging was determined by thoracic CT (in all patients) and/or CT-PET scan. Age, sex, smoking history, pulmonary function (50 patients), presence of PE in CT, one-year response (RECIST criteria) and one-year survival were evaluated. <bold>Results</bold> One hundred and ten patients were included (65% women), aged 65±8 (X±SD), FEV1/FVC 60±13%, FEV1 71±19%, KCO 65±19%, squamous cell carcinoma 20%, adenocarcinoma 74%, others 6%. The staging was: III 6%, IVa 40%, IVb 54%. Sixty percent of patients were diagnosed with PE and 63% with COPD (from those who had spirometry). Patients with PE responded better to IO (50%, p<0.05) with increased survival (57%, p=0.1) than those without (18 and 41%, respectively). Patients with COPD also showed better response (45%, p=0.05) compared to patients without (19%). The multivariate analysis demonstrated that the only independent variable associated with less progression was the presence of PE. <bold>Conclusions</bold> Our preliminary results suggest that PE could be a determining factor for a good response to IO in patients with advanced stages of NSCLC.