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Review
. 2024 Dec 9:19:2689-2703.
doi: 10.2147/COPD.S490252. eCollection 2024.

COPD and Immune Checkpoint Inhibitors for Cancer: A Literature Review

Thomas W Lycan Jr  1 , Dustin L Norton  1 , Jill A Ohar  1
Affiliations
Review

COPD and Immune Checkpoint Inhibitors for Cancer: A Literature Review

Thomas W Lycan Jr et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Immune checkpoint inhibitors are a standard treatment option for many patients with cancer and are most frequently used to treat lung cancer. Chronic obstructive pulmonary disease (COPD) is the most common comorbidity of patients with lung cancer. As the cancer-specific survival of patients with lung cancer continues to increase with modern treatments, it is critical to optimize comorbidities to improve overall survival. This literature review aimed to summarize current research on the impact of COPD upon immunotherapy outcomes.

Methods: A comprehensive search was conducted in the PubMed database using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria focused on peer-reviewed articles published between 2010 and 2024 that addressed COPD, cancer, and immune checkpoint inhibitors. The study team screened the studies for relevance and then synthesized them narratively.

Results: This review identified 37 studies that met the inclusion criteria. Findings suggest that COPD is predictive of improved efficacy but slightly worse toxicity from immune checkpoint inhibitor therapy. The chronic inflammation of COPD leads to immune exhaustion including the overexpression of immune checkpoints on T-cells. Particularly within "hot" tumors that have higher concentrations of tumor-infiltrating lymphocytes, the COPD-related increase in programmed cell death protein 1 (PD-1) signaling likely creates sensitivity to immune checkpoint inhibitors. However, COPD can also lead to respiratory dysfunction, debility, and interstitial lung disease; each of which increases the severity of immune-related adverse events.

Conclusion: COPD is a critical comorbidity that has a significant impact on many patients with cancer who receive treatment with immune checkpoint inhibitors. Future research is needed to design interventions to optimize COPD care in this high-risk patient population.

Keywords: COPD; immune checkpoint inhibitors; immunotherapy; lung cancer.

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Conflict of interest statement

Dr Jill Ohar reports grants from Teva, grants from Boehringer Ingelheim, grants from Mylan, personal fees from Astra Zeca, personal fees from Chiesi, personal fees from Boehringer Ingelheim, personal fees from Verona, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Conceptual model for immunotherapy outcomes among patients with COPD and cancer.
See this image and copyright information in PMC

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