Impact of opioid analgesics on the efficacy of immune checkpoint inhibitors in a lung cancer population

Objective A retrospective clinical study was conducted to compare the prognosis between the opioid analgesic (OA) treated and OA-untreated groups and to evaluate the effect of opioid analgesics on the efficacy of immune checkpoint inhibitors (ICIs) in the treatment of advanced lung cancer patients. In addition, a subgroup analysis of the clinical characteristics of the enrolled patients was performed to explore possible influencing factors. Methods This study reviewed the medical records of eligible patients who received ICIs at our institution. The clinicopathological features and clinical outcomes were compared. Also, the use of OA was collected. Patient survival, the incidence of immune-related adverse events (irAEs), and other baseline variables were examined in both cohorts according to whether OA was used. Results A total of 132 patients were included in the study. Of them, 39 (29.5%) were in the OA-treated group. No significant differences in baseline characteristics were observed between the OA-treated and untreated groups. The combined application of OA treatment significantly shortened progression-free survival (PFS) (P < 0.001) and overall survival (OS) (P = 0.002). However, both groups experienced similar incidences and gradations of irAEs. According to multivariate analysis, OA treatment resulted in significantly worse PFS (HR = 4.994, 95% CI 3.217-7.753, P < 0.001) and OS (HR = 3.618, 95% CI 2.030-6.240, P < 0.001). Conclusions Clinical outcomes of ICIs were significantly diminished in a cohort of Chinese patients with advanced lung cancer receiving OA therapy.