Survival in Immune Checkpoint Inhibitor-Treated Patients With Rheumatoid Arthritis and Non-Small Cell Lung Cancer: An...

Area of Science:

• Oncology
• Immunology
• Rheumatology

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, including for metastatic non-small cell lung cancer (mNSCLC).
• The impact of pre-existing rheumatoid arthritis (RA) on treatment outcomes with ICIs in mNSCLC is not well understood.
• Understanding survival differences is crucial for optimizing treatment strategies.

Purpose of the Study:

• To compare overall survival (OS) in patients with mNSCLC treated with ICIs who have pre-existing rheumatoid arthritis (RA) versus those without RA.
• To investigate the influence of RA on ICI treatment efficacy in mNSCLC.
• To analyze factors associated with survival in this patient population.

Main Methods:

• Retrospective cohort study utilizing Medicare claims data.
• Included patients aged ≥66 years with mNSCLC initiating nivolumab, pembrolizumab, or atezolizumab.
• Survival analysis performed using Kaplan-Meier curves and adjusted Cox proportional hazard models.

Main Results:

• A total of 2,732 patients with mNSCLC were analyzed (790 with RA, 1,942 without RA).
• Patients with RA were more likely to be female, have more comorbidities, and use steroids prior to ICI initiation.
• No significant difference in OS was observed between the RA and non-RA groups (log-rank P = 0.08; adjusted HR 0.92).
• Male sex, comorbidities, and steroid dose before ICI initiation were associated with worse OS.
• In a sensitivity analysis excluding dexamethasone users, steroid dose was not linked to worse OS.

Conclusions:

• Pre-existing rheumatoid arthritis (RA) did not significantly impact overall survival (OS) in patients with metastatic non-small cell lung cancer (mNSCLC) treated with immune checkpoint inhibitors (ICIs).
• After controlling for demographic and comorbidity factors, ICI-treated mNSCLC patients with RA demonstrated comparable OS to those without RA.
• Steroid use, particularly dexamethasone, requires further investigation regarding its role in OS for this patient cohort.