Obstructive lung disease in smokers and never smokers: further insights in patient-related approach in lung cancer understanding

Although smoking still represents the leading cause of lung cancer, obstructive lung disease is another independent risk factor. In chronic obstructive pulmonary disease (COPD), a systemic inflammatory disorder with specific tumor immune environment, this risk is two- to five-fold greater compared with smoking without COPD (1,2). Thus, when managing patients with non-small cell lung cancer (NSCLC) for curative treatment, (surgery, but also immune check points inhibitors in non-surgical patients), associated COPD should be taken into account, because of increased post-operative risk (3-6) on one side, but possible increased efficacy of anti PD1/PDL1 immunotherapy (7).