Unveiling the role of atezolizumab in non-small cell lung cancer and coexisting chronic obstructive pulmonary disease — a comprehensive review

Introduction. The coexistence of non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary dis­ease (COPD) is commonly observed, primarily due to overlapping risk factors like smoking and environmental exposures. This dual diagnosis introduces complex clinical scenarios, often associated with worsened out­comes and heightened vulnerability to treatment-related side effects. Immune checkpoint inhibitors, especially atezolizumab, have emerged as pivotal agents in enhancing clinical outcomes for individuals diagnosed with NSCLC. Recent evidence suggests that atezolizumab remains effective and well-tolerated in NSCLC patients with coexisting COPD. This review evaluates the efficacy and safety of atezolizumab in NSCLC patients with coexisting COPD. Methods. Literature related to atezolizumab use in NSCLC patients with coexisting COPD was retrieved from PubMed, Embase, and Scopus databases, covering all studies published until June 1, 2025. Both randomized trials and real-world evidence were analyzed. Results. Findings from major clinical trials such as OAK, POPLAR, IMpower110, and IMpower150, along with real-world data, demonstrate that atezolizumab enhances both progression-free and overall survival, without a nota­ble rise in immune-mediated adverse effects like pneumonitis., particularly in patients with mild-to-moderate COPD. Conclusions. Atezolizumab demonstrates significant efficacy and a favorable safety profile in NSCLC patients with COPD, particularly among those with GOLD stage I–II disease.