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Effect of type 2 diabetes mellitus on systemic treatment for advanced non-small cell lung cancer

Yasuhiro Kato1, Eri Kuramochi1, Rei Yamaguchi1

  • 1Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan.

Translational Lung Cancer Research
|September 15, 2025
PubMed
Abstract

Insights

Type 2 diabetes mellitus (T2DM) negatively impacts advanced non-small cell lung cancer (NSCLC) treatment outcomes, particularly with immune checkpoint inhibitors. Specialist consultation may improve progression-free survival for T2DM patients receiving ICI therapy.

Area of Science:

  • Oncology
  • Endocrinology
  • Clinical Research

Background:

  • The impact of type 2 diabetes mellitus (T2DM) on advanced non-small cell lung cancer (NSCLC) treatment is not well understood.
  • This study investigates how T2DM affects treatment efficacy and safety in advanced NSCLC patients.

Purpose of the Study:

  • To assess the influence of T2DM on the outcomes of advanced NSCLC patients receiving systemic therapies.
  • To identify prognostic factors for progression-free survival in T2DM patients undergoing immune checkpoint inhibitor (ICI) therapy.

Main Methods:

  • Retrospective analysis of advanced NSCLC patients treated from 2018 to 2024.
  • Comparison of treatment effects and adverse events between T2DM and non-T2DM patient cohorts.
  • Evaluation of overall survival (OS) and progression-free survival (PFS) across different treatment modalities (ICI, MTT, CTT).

Main Results:

  • T2DM patients had significantly worse OS compared to non-T2DM patients overall, and specifically in the ICI and molecular targeted therapy (MTT) cohorts.
  • Median PFS was significantly poorer for T2DM patients in the ICI cohort but not in the MTT cohort.
  • No significant differences in adverse events were observed; however, higher HbA1c correlated with elevated dNLR. Specialist consultation improved PFS in the ICI cohort.

Conclusions:

  • T2DM is an independent poor prognostic factor for advanced NSCLC patients.
  • T2DM significantly affects the efficacy of immune checkpoint inhibitor (ICI) therapy in advanced NSCLC.
  • Specialist consultation is a potential factor for improving outcomes in T2DM patients receiving ICI treatment.
Keywords:
Immune checkpoint inhibitor (ICI)non-small cell lung cancer (NSCLC)systemic treatmenttype 2 diabetes mellitus (T2DM)

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