Comorbid COPD Associated With Worse Survival in Patients With NSCLC Treated With EGFR-TKI

For patients with non—small cell lung cancer (NSCLC) being treated with an epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI), the presence of co-existing COPD is associated with worse survival, according to researchers from Taiwan.

The study of more than 21,000 patients showed that after a median follow-up of 2.1 years, patients with comorbid COPD had a median overall survival (OS) of 2.04 years compared with a median OS of 2.28 years among patients without the comorbidity. Patients with NSCLC with underlying COPD also had significantly worse progression-free survival (PFS) (0.62 years vs 0.69 years).

Patients with lung cancer tend to be older, and as a result, are more likely to have comorbidities, including COPD. But while previous research has shown that COPD increases the risk of NSCLC, there has been less research on the survival impact of COPD in metastatic NSCLC. More specifically, there is a lack of evidence on the role of COPD in patients treated with EGFR-TKIs. The researchers believe this is the first study to emphasize the role of COPD in selecting the drug class for patients with NSCLC.

“In the era of targeting therapy for lung cancer, EGFR-TKI have been proven as the pivotal therapeutic role for NSCLC harboring an active EGFR mutation in terms of response rate, PFS and OS,” wrote the researchers. “Several studies emphasized that the frequency of EGFR mutation increased with several clinicopathologic factors, including adenocarcinoma, never smoker, and being female. As COPD is a well-known smoking-related disease, the incidence of an EGFR mutation in COPD patients with lung cancer might be lower than in non-COPD patients.”

Researchers used the Taiwan National Health Insurance Research Database, which includes longitudinal healthcare claims data, to collect information on the 21,026 patients diagnosed with NSCLC, including those with COPD, who were treated with either gefitinib or erlotinib. Among the patients, 62% received gefitinib, 47% received erlotinib, and 9% received both.

While the patients with COPD were slightly older than those without COPD (65.6 vs 64.9 years), there were no other significant differences between the 2 groups when it came to gender, premium level, comorbidity, or use of anti-neoplastic agents.

The researchers performed propensity score (PS) matching to analyze 8531 patients with NSCLC and COPD and an equal amount of patients with just NSCLC. Results were similar to those seen before the PS matching, with patients with COPD having significantly worse PFS (0.43 years vs 0.47 years) and OS (1.71 years vs 1.75 years) compared with patients without COPD.

Reference:

Wu C, Rau K, Lee W, et al. Presence of chronic obstructive pulmonary disease (COPD) impair survival in lung cancer patients receiving epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI): a nationwide population-based cohort study [published online July 12. 2019]. J Clin Med. doi: 10.3390/jcm8071024.