Efficacy And Safety Of ICIs In Lung Cancer Patients With Concomitant COPD: A Meta-analysis Of Observational Studies

Background and objective:Lung cancer is currently the most frequently diagnosed malignant tumor,representing the leading cause of cancer death all over the world.And chronic obstructive pulmonary disease（COPD）is considered to be one of the important comorbid diseases in lung cancer patients.Immunotherapy has been one of the great advances in the recent years for the treatment of advanced tumors,bringing great benefits to patients with lung cancer.At the same time,Immune checkpoint inhibitors（ICIs）can also lead to serious Immune related adverse events（ir AEs）.At present,there is no unified conclusion on the effect and safety of COPD on ICIs.The purpose of this study is to investigate efficacy and safety of ICIs in patients with lung cancer concomitant with COPD,so as to provide help to clinical treatment.Methods:A comprehensive search was conducted using Pub Med,Embase,Web of Science,and Cochrane library for articles published before 31 December 2021.Collect the literatures related to the efficacy and safety of ICIs in lung cancer patients with concomitant COPD.The languages were limited to English.The eligible studies were screened strictly in accordance with the pre-formulated inclusion and exclusion criteria,the NOS scale was applied to assess the quality of the included literature,and the baseline characteristics and outcomes were extracted of the final included literatures.Fixed effect or random effect model were applied to calculate the Hazard ratio（HR）and95% confidence interval（CI）of overall survival（OS）and progression-free survival（PFS）as the influencing indexes of efficacy.Fixed effect or random effect model were used to calculate the Odd ratio（OR）and 95%CI as influencing indicators of safety.Heterogeneity test and funnel plot evaluation of publication bias were completed by Rev Man5.3 software.Results:1.In the end,4 literatures on the efficacy of ICIs in lung cancer patients with concomitant COPD were used for this meta-analysis.In terms of OS,the survival time was improved in ICIs-treated lung cancer patients who combined COPD compared with those without,with a statistically significant difference[HR=0.68,95%CI（0.51-0.90）,P=0.008],In the matter of PFS,the progression-free survival time was prolonged in ICIs-treated lung cancer patients who combined COPD compared with those without,with a statistically significant difference[HR=0.56,95%CI（0.42-0.73）,P<0.0001].2.In the end,7 literatures were included on the safety of ICIs in lung cancer patients with concomitant COPD.Compared with those without concomitant COPD,the incidence of immune-related adverse events in ICIs-treated lung cancer patients showed an increasing trend,but there was no statistical difference [OR=1.38,95%CI（0.95-2.02）,P=0.09].Conclusions:1.COPD was associated with better efficacy in lung cancer patients treated with ICIs.2.COPD had no significant effect on safety in lung cancer patients treated with ICIs.