Perioperative LAMA/LABA inhaled therapy optimal for patients with lung cancer, COPD

Perioperative combination therapy using a long-acting muscarinic antagonist and long-acting beta agonist may be an optimal treatment for patients with lung cancer and COPD undergoing cancer for lung surgery, researchers reported.

“Because the prognosis of patients with lung cancer complicated by COPD is reportedly poor, it is important to provide respiratory care for an extended duration, not just during the perioperative period,” Yoko Azuma, MD, assistant professor in the division of chest surgery at Toho University School of Medicine, Tokyo, Japan, and colleagues wrote in BMC Pulmonary Medicine. “The aim of this study [was] to determine the effects of perioperative LAMA/LABA therapy on perioperative lung function, postoperative morbidity and mortality, and long-term prognosis for patients with COPD and lung cancer.”

Researchers conducted a retrospective review of medical records of 130 consecutive patients who were newly diagnosed with COPD and underwent lung cancer surgery from January 2005 to October 2019. All patients received perioperative rehabilitation before being categorized into groups according to the type of perioperative inhaled therapy and management used: 64 patients received combination LAMA/LABA, 23 patients received LAMA only and 43 received rehabilitation only.

The researchers reported that values for FEV₁ and FEV₁ percent predicted were significantly improved among patients who received preoperative LAMA/LABA therapy before lung cancer surgery (P < .001 for both). Lung function was significantly improved with LAMA/LABA therapy compared with patients receiving preoperative LAMA therapy (FEV1, 223.1 mL vs. 130 mL; FEV₁ percent predicted, 10.8% vs. 6.8%).

Patients who received LAMA/LABA had a lower frequency of postoperative complications compared with patients who received LAMA only (P = .007). Those who received LAMA/LABA had lower rates of any complications (21.9% vs. 52.2%), pneumonia (10.9% vs. 26.1%), acute respiratory failure (1.6% vs. 8.7%), prolonged air leakage (9.4% vs. 21.7%) and atrial fibrillation (6.3% vs. 8.7%).

Compared with patients who received LAMA only or rehabilitation only, of the 61 patients with moderate-to-severe air flow limitation, those who received LAMA/LABA therapy had significantly longer overall survival (P = .049 and P = .001) and disease-free (P = .026 and P < .001) survival.

Researchers also observed an association between lower recurrence rates and perioperative LAMA/LABA therapy compared with LAMA only (P = .006) and rehabilitation only (P = .008).

“Our data demonstrate that LAMA/LABA therapy improves not only short-term outcomes such as respiratory function and postoperative complications, but also long-term prognosis in patients with lung cancer and COPD,” the Azuma and colleagues wrote. “Perioperative combined LAMA/LABA therapy is the optimal bronchodilator for patients with COPD who require surgery for lung cancer.”