Zeitschrift für Krebswissenschaft und -forschung
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COPD exacerbations affect clinical outcome in advanced non small cell lung cancer: a retrospective analysis

Alessandro Mazzocca

Background: Non small cell lung cancer is the leading cause of cancer death worldwide. The increasing life expectancy is due to the improvement in medical treatments including the target therapy, immunotherapy and the maintenance therapy. COPD is a disease often associated and it is characterized over the course by symptoms exacerbations. Chronic Obstructive Pulmonary Disease (COPD) is widely accepted to be an indipendent risk factor for lung cancer.

Objective: The aim of the present study was to determine the effects of COPD exacerbations on the outcome of patients treated with cisplatin-pemetrexed in metastatic lung adenocarcinoma. The main endpoint was to detect the effects of COPD exacerbations on time to progression (TTP). The secondary endpoint was to highlight the effects of exacerbations on treatment toxicity.

Methods: 120 patients affected by COPD and adenocarcinoma IV stage wild type for EGFR mutation, were elegible for analysis. The inclusion criteria were ECOG PS 0-2, all treated with cisplatin-pemetrexed. Exclusion criteria included severe comorbidities and ECOG PS>2. The initial population was subdivided in two subgroups according to the presence (group 0) or absence of COPD exacerbations (group 1).

Results: The groups were homogeneous in terms of age, gender, staging, and smoking habit.

The exacerbations were defined as a changes in patients’ pulmonary symptoms necessitating antibiotics and/or oral steroids. A validated questionnaire called COPD assessment test (CAT) was performed to assess symptoms consisting of 8 items. The score ranges from 0 to 40 and the cutoff score indicative of exacerbation is 10.

The group of patients without COPD exacerbations (group 1) reported a better TTP (log-rank HR of 0.31; p<0.0001) compared with group 0. The TTP median value was longer in group 1 (8.2 vs 6.6 months), and the difference was statistically significant (p<0.0001).

The overall response rate was major in the group 1 compared with the group 0: 45% vs 37% (p<0.001)

Toxicity events were similar in both groups, except for fatigue that was lower group 1 (p<0.0001).

Conclusions: The presence of COPD exacerbations influences the outcome in patients treated for wild type lung adenocarcinoma, both in terms of TTP and in terms of response rate and toxicity.