Lung Cancer in the Course of COPD-Emerging Problems Today

SIMPLE SUMMARY: Chronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer independent of the influence of tobacco smoke. There are some similarities in immunopathogenesis of both diseases. The participation of inflammatory cells: macrophages, neutrophils and lymphocytes T with CD8 population was presented in both diseases. The emphysematous phenotype of COPD seems to be most often complicated by lung cancer. Some elements of autoimmunity could be involved in the development of emphysema, and its relation with malignant transformation requires further studies. COPD complicates lung cancer diagnosis and treatment, and the patients with coexistence of these both serious diseases need special care. ABSTRACT: Tobacco smoking remains the main cause of tobacco-dependent diseases like lung cancer, chronic obstructive pulmonary disease (COPD), in addition to cardiovascular diseases and other cancers. Whilst the majority of smokers will not develop either COPD or lung cancer, they are closely related diseases, occurring as co-morbidities at a higher rate than if they were independently triggered by smoking. A patient with COPD has a four- to six-fold greater risk of developing lung cancer independent of smoking exposure, when compared to matched smokers with normal lung function. The 10 year risk is about 8.8% in the COPD group and only 2% in patients with normal lung function. COPD is not a uniform disorder: there are different phenotypes. One of them is manifested by the prevalence of emphysema and this is complicated by malignant processes most often. Here, we present and discuss the clinical problems of COPD in patients with lung cancer and against lung cancer in the course of COPD. There are common pathological pathways in both diseases. These are inflammation with participation of macrophages and neutrophils and proteases. It is known that anticancer immune regulation is distorted towards immunosuppression, while in COPD the elements of autoimmunity are described. Cytotoxic T cells, lymphocytes B and regulatory T cells with the important role of check point molecules are involved in both processes. A growing number of lung cancer patients are treated with immune check point inhibitors (ICIs), and it was found that COPD patients may have benefits from this treatment. Altogether, the data point to the necessity for deeper analysis and intensive research studies to limit the burden of these serious diseases by prevention and by elaboration of specific therapeutic options.