Efficacy and safety of Immune Checkpoint Inhibitors in Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema

<bold>Background:</bold> Immune checkpoint inhibitors (ICIs) are the mainstream drug therapy for lung cancer. Patients with interstitial pneumonia are at increased risk of ICI-related interstitial lung disease (ILD); however, the association of combined pulmonary fibrosis and emphysema (CPFE) and thick walled cystic lesions (TWCLs) in CPFE remains unclear. <bold>Aim:</bold> This study aimed to evaluate the efficacy and safety of ICls in lung cancer patients complicated with CPFE and TWCLs. Method: The study retrospectively evaluated the clinical characteristics and prognosis of lung cancer patients who were treated with ICls at our hospital between 2016 and 2023. <bold>Results:</bold> A total of 175 patients (126 males and 49 females) who received ICls for lung cancer were included. Among them, 30 patients had interstitial pneumonia (IP), 21 had CPFE, and 12 had TWCLs in CPFE with median overall survival (OS) of 804, 645, and 711 days, respectively. The OS of patients with uncomplicated IP/CPFE was 1,128 days, which was significantly longer than the OS in complicated IP/CPFE cases (P = 0.0239 and 0.0176). Patients with IP/CPFE complications exhibited a significantly higher incidence of ICI-related interstitial lung disease than those without IP/CPFE complications. However, there were no significant differences in OS or the incidence of ICI-related ILD in patients with and without TWCLs. <bold>Conclusions:</bold> CPFE patients receiving ICIs could be associated with increased risks of shorter OS and the development of ICI-related ILD; however, this risk remained unaffected by the presence or absence of TWCLs. These results provide useful insights for future lung cancer treatments.