413P - Association of concomitant medications on survival outcomes in cancer patients treated with immune checkpoint inhibitors: Analysis of health insurance review and assessment database

Background

Recent evidence suggested that medications regulating immune homeostasis and gut microbiota could affect the efficacy of immune checkpoint inhibitors (ICI). This study aimed to investigate the impact of concomitant medications on the survival outcomes in cancer patients treated with ICI in Korean population data.

Methods

The study population was selected from the Health Insurance Review and Assessment Service (HIRA) database in Korea. We identified patients newly treated with ICI for non-small cell lung cancer (NSCLC), urothelial carcinoma (UC), and malignant melanoma (MM) from Aug 2017 to June 2020. ICI was reimbursed as 2^nd line in NSCLC and UC and as 1^st line in MM. Concomitant medication use was defined as prescribed medication within 30 days before the date of ICI initiation. We assessed the association of concomitant medication (antibiotics (ATB), corticosteroids (CS), proton-pump inhibitors (PPI), and opioids) on treatment duration and survival.

Results

We identified 8,870 patients as ICI cohort; 7,128 with NSCLC, 960 with UC, and 782 with MM. The median age was 66 years (range, 60-73), and two-thirds of patients were male. The patients were prescribed baseline ATBs (33.8%), CS (47.8%), PPIs (28.5), and Opioids (53.1%), respectively. Median ICI treatment durations were 72 days in NSCLC, 85 days in UC, and 127.5 days in MM. Median overall survivals were 11.1m in NSCLC, 12.2m in UC, and 22.1m in MM. In the multivariable analysis, opioids and CS were strongly associated with poor survival across all three cancer types. In NSCLC, ATB and PPI use were associated with inferior OS (6.3 vs. 12.1 months, HR=1.29, 95% CI 1.21-1.38 and 8.1 vs. 13.4 months, HR-1.18, 95% CI 1.10-1.26). In UC, ATB use was associated with poor OS (8.1 vs. 12.6 months, HR=1.24, 95% CI 1.03-1.50). However, ATB and PPI use did not affect survival in the MM cohort.

Conclusions

Our real-world data demonstrate that opioid and CS use are associated with poor prognosis in NSCLC, UC, and MM patients treated with ICI. However, the effect of ATB and PPI use on survival differed significantly depending on the type of cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.