Associations Between Anxiety or Depression Diagnosis and Immune Checkpoint Inhibitor Outcomes

Anxiety and depression can affect immune function, yet little is known about their impact on immune checkpoint inhibitor (ICI) therapy outcomes. We investigated associations between an existing anxiety or depression diagnosis and ICI outcomes.

In this secondary analysis, multicenter retrospective real-world data were abstracted from medical charts. Patients included received ≥ 1 dose of anti-PD-1 or anti-PD-L1 monotherapy. Key variables abstracted were anxiety/depression diagnosis at treatment initiation, ICI therapy outcomes (immune-related adverse events, irAEs; overall survival, OS; time to treatment failure, TTF), and other sociodemographic and clinical factors.

Of the 913 patients, 11% and 12% had an existing anxiety or depression diagnosis, respectively. Rates of any grade irAEs were 32% overall, and 44% and 37% among those with anxiety or depression history, respectively. In the multivariable analysis, patients with an anxiety diagnosis had a greater likelihood of experiencing irAEs (OR = 1.80; 95% CI = 1.16-2.79, p = 0.009) and better OS (HR = 0.74; 95% CI = 0.54-1.00, p = 0.048) compared to those without an anxiety diagnosis. Depression diagnosis was not significantly associated with irAEs, OS, or TTF. In multivariable sensitivity analyses restricted to patients with non-small cell lung cancer (NSCLC, n = 417), those with an anxiety diagnosis had a trend toward better OS (HR = 0.66; 95% CI = 0.43-1.01; p = 0.056) and longer TTF (HR = 0.71; 95% CI = 0.50-1.02; p = 0.063) than those without an anxiety diagnosis, while irAEs did not vary significantly by anxiety.

Pre-existing anxiety diagnosis may impact clinical outcomes for patients receiving anti-PD-1 or anti-PD-L1 treatments. Links between psychosocial factors and ICI outcomes should be further examined in translational and prospective studies.