Evaluating the impact of COPD exacerbations on survival outcomes in non-small cell lung cancer patients receiving immunotherapy: A retrospective cohort analysis.

Abstract

e20613 Background: Advances in immunotherapy have changed the treatment landscape for advanced non-small cell lung cancer (NSCLC). Recent studies suggest that patients with coexisting chronic obstructive pulmonary disease (COPD) may respond better to immunotherapy, possibly due to the unique immunological environment associated with COPD. However, frequent COPD exacerbations, which often necessitate the use of systemic corticosteroids, may affect the response to immunotherapy. We aimed to address a critical gap in knowledge by evaluating the survival outcomes of NSCLC patients with and without a history of COPD exacerbations undergoing immunotherapy. Methods: Data from 103 healthcare organizations in the TriNetX database were analyzed. Two matched cohorts of NSCLC patients treated with immunotherapy were identified: Cohort 1 included patients with a history of COPD exacerbations (n=1,335), and Cohort 2 included patients without COPD (n=1,335). The propensity score matching balanced age, sex, and co-morbidities. Kaplan-Meier survival analysis and Cox proportional hazards models assessed overall survival (OS), risk of death, and hazard ratios (HR). Statistical significance was set at p < 0.05. Results: Baseline characteristics were well matched after propensity score adjustment, ensuring comparability between the groups. Patients with COPD exacerbations (Cohort 1) had significantly worse outcomes compared to those without COPD (Cohort 2). The risk of death was higher in Cohort 1 (64.2%) than in Cohort 2 (59.5%), with a risk difference of 4.7% (95% CI: 1.0-8.4%, p=0.012). Median OS was shorter in Cohort 1 (418 days) compared to 543 days in Cohort 2, reflecting a substantial difference in survival duration. Kaplan-Meier analysis showed a survival probability of 0.00% for Cohort 1 at the study endpoint, compared to 21.03% in Cohort 2 (log-rank p<0.001). The hazard ratio for death in Cohort 1 was 1.22 (95% CI: 1.11-1.35, p<0.001), indicating a 22% higher mortality risk. Conclusions: This study shows that NSCLC patients with COPD exacerbations experience significantly worse survival outcomes with immunotherapy compared to patients without COPD. These findings highlight the adverse impact of COPD exacerbations on immunotherapy efficacy and the need to explore treatment strategies that will improve patient outcomes. Impact of COPD exacerbations on mortality and survival outcomes in NSCLC patients. Cohort Risk of death Risk difference Median OS (days) HR NSCLC with history of COPD exacerbations (n=1,335) 64.2% 4.7% (95% CI: 1.0-8.4%, p=0.012) 418 1.22 (95% CI: 1.11-1.35, p<0.001) NSCLC without COPD (n=1,335) 59.5% 543