Treatment Strategies for Non-Small-Cell Lung Cancer with Comorbid Respiratory Disease; Interstitial Pneumonia, Chronic Obstructive Pulmonary Disease, and Tuberculosis

Simple Summary Lung cancer patients are frequently complicated by various respiratory diseases during their course. In particular, interstitial pneumonia and chronic obstructive pulmonary disease are often associated with lung cancer due to their common pathogenesis, and acute exacerbations of these diseases can be fatal. Therefore, it is important to select a therapy that is less likely to induce acute exacerbations of interstitial pneumonia and chronic obstructive pulmonary disease. Furthermore, lung cancer patients are at high risk of developing or reactivating pulmonary tuberculosis triggered by pharmacotherapy and often struggle with the diagnosis and treatment of tuberculosis complicated by lung cancer. This review summarizes the current evidence regarding pharmacotherapy for lung cancer patients with interstitial pneumonia, chronic obstructive pulmonary disease, and pulmonary tuberculosis and discusses future prospects.Abstract Non-small cell lung cancer (NSCLC) patients are often complicated by other respiratory diseases, including interstitial pneumonia (IP), chronic obstructive pulmonary disease (COPD), and pulmonary tuberculosis (TB), and the management of which can be problematic. NSCLC patients with IP sometimes develop fatal acute exacerbation induced by pharmacotherapy, and the establishment of a safe treatment strategy is desirable. For advanced NSCLC with IP, carboplatin plus nanoparticle albumin-bound paclitaxel is a relatively safe and effective first-line treatment option. Although the safety of immune checkpoint inhibitors (ICIs) for these populations remains controversial, ICIs have the potential to provide long-term survival. The severity of COPD is an important prognostic factor in NSCLC patients. Although COPD complications do not necessarily limit treatment options, it is important to select drugs with fewer side effects on the heart and blood vessels as well as the lungs. Active TB is complicated by 2-5% of NSCLC cases during their disease course. Since pharmacotherapy, especially ICIs, reportedly induces the development of TB, the possibility of developing TB should always be kept in mind during NSCLC treatment. To date, there is no coherent review article on NSCLC with these pulmonary complications. This review article summarizes the current evidence and discusses future prospects for treatment strategies for NSCLC patients complicated with IP, severe COPD, and TB.