2098P - The impact of concomitant use of non-opioid analgesics and immune checkpoint inhibitors on survival in lung cancer patients: A Hong Kong population-based cohort study

Background

Pain is one of the most common symptoms experienced by advanced staged lung cancer patients. Non-opioid analgesics like acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) have been the cornerstone of pharmacologic interventions for cancer pain management in lung cancer. Since cyclooxygenase-2 (COX2) is overexpressed in many solid tumors including lung cancer and is associated with poor prognosis, COX inhibitions such as NSAIDs have been the candidate for adjuvant therapy for lung cancer. Yet the results of previous studies regarding the concomitant use of immune checkpoint inhibitors (ICIs) and non-opioid analgesics remained controversial mostly for their small sample size. This study aims to investigate whether the concomitant use of NSAIDs with ICIs can improve the survival of lung cancer compared to acetaminophen.

Methods

A total of 572 lung cancer patients who received concomitant use of non-opioid analgesics and ICI from 2018 to 2020 were identified within the Clinical Data Analysis and Reporting System of Hong Kong. Inverse probability of treatment weighting (IPTW) –adjusted Kaplan-Meier curves and Cox proportional hazards regression analysis were used to compare the overall survival (OS) of patients who received NSAIDs versus acetaminophen.

Results

Overall, 428 (74.8%) and 144 (25.2%) patients with lung cancer received concomitant ICI with acetaminophen and NSAIDs, respectively. The median follow-up time in the weighted population was 39.1 months (95% CI, 36.6-43.5 months). IPTW-adjusted Kaplan-Meier curves showed that the median OS was significantly longer in the NSAIDs group than in the acetaminophen group (15.4 months vs 10 months, p = 0.03). In IPTW-adjusted Cox regression analysis, the concomitant use of NSAIDs with ICI was associated with a significant OS benefit (HR = 0.76, 95% CI: 0.61-0.96, p = 0.02).

Conclusions

The concomitant use of NSAIDs with ICI was associated with improved survival in patients with lung cancer compared with that of acetaminophen. Our findings suggest that a more cautious combination of non-opioid analgesics with ICI for cancer pain management in lung cancer is warranted.

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.