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Crosstalk Between Opioids and the Anti-Tumour Immune Checkpoint Axis
Parsa Alan1, Marie-Odile Parat2
1Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia.
Current Oncology (Toronto, Ont.)
|July 27, 2026
Summary
Opioid use may worsen cancer immunotherapy outcomes by interfering with PD-1/PD-L1 pathways. Research suggests opioid-sparing strategies could improve results for patients on immune checkpoint inhibitors.
Area of Science:
- Oncology
- Immunology
- Pharmacology
Background:
- Opioids are common for cancer pain.
- Evidence links opioid exposure to poorer outcomes with immune checkpoint inhibitors (ICIs).
Purpose of the Study:
- To review evidence on how opioids interact with the PD-1/PD-L1 pathway.
- To assess clinical outcomes of patients receiving ICIs with concurrent opioid use.
Main Methods:
- Literature search up to January 2026 for preclinical and clinical studies.
- Focused on opioid effects on PD-1/PD-L1 biology and ICI outcomes.
Main Results:
- Preclinical data show opioids can increase PD-L1, alter immune responses, and impair T-cell function.
- Clinical studies associate opioid use (higher doses) with worse progression-free survival, overall survival, and treatment duration in non-small cell lung cancer and other cancers.
Conclusions:
- Opioid signaling intersects with PD-1/PD-L1 biology via cancer and immune cells.
- Opioid-sparing approaches or peripheral antagonism may enhance ICI efficacy.
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