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Original research
Opioids impair nivolumab outcomes: a retrospective propensity score analysis in non-small-cell lung cancer
  1. Yoshihiko Taniguchi1,
  2. Akihiro Tamiya1,
  3. Yoshinobu Matsuda2,
  4. Yuichi Adachi3,
  5. Takatoshi Enomoto3,
  6. Kouji Azuma4,
  7. Shunichi Kouno5,
  8. Akihiro Tokoro2 and
  9. Shinji Atagi6
  1. 1 Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
  2. 2 Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
  3. 3 Respiratory Medicine and Clinical Immunology, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
  4. 4 Respiratory Medicine, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan
  5. 5 Respiratory Medicine, Gunma University Graduate School of Medicine School of Medicine, Maebashi, Japan
  6. 6 Clinical Research Center, Kinki-Chuo Chest Medical Center, Sakai, Japan
  1. Correspondence to Dr Yoshihiko Taniguchi, Kinki Chuo Chest Medical Center, Sakai 591-8555, Japan; taniguchi.yoshihiko.ny{at}mail.hosp.go.jp

Abstract

Objectives Opioids are often administered for cancer-related pain relief. However, few reports have evaluated the association between opioids and immune checkpoint inhibitor treatment for patients with non-small-cell lung cancer (NSCLC). The aim of this retrospective study was to reveal the effect of opioids on the prognosis of patients harbouring NSCLC treated with nivolumab.

Methods The medical records of consecutive patients with NSCLC receiving nivolumab at our institution were retrospectively reviewed. We collected clinical data at the time of nivolumab treatment initiation. Propensity score matching (PSM) was performed to minimise potential selection bias. We compared clinical outcomes with and without baseline opioid use.

Results Of the 296 patients identified in the study, after PSM, 38 cases with opioid use and matched 38 cases without opioid use were selected. The overall response rate was significantly lower in patients with opioid use than in those without (2.63%, 95% CI 0.47% to 13.49%, vs 21.05%, 95% CI 11.07% to 36.35%; p=0.0284). The median progression-free survival in patients with opioid use was significantly shorter than that in patients without (1.17, 95% CI 0.93 to 1.73 months, vs 2.07 95% CI 1.23 to 4.73 months; p=0.002). The median overall survival in patients with opioid use was significantly shorter than that in patients without (4.20, 95% CI 2.53 to 6.20 months, vs 9.57, 95% CI 2.23 to not reached months; p=0.018).

Conclusions Patients with NSCLC receiving regular opioid administration at nivolumab treatment initiation had a worse nivolumab treatment outcome than patients without opioid use.

  • lung
  • pain
  • drug administration
  • prognosis
  • supportive care

Data availability statement

Data are available upon reasonable request. Please contact Yoshihiko Taniguchi (E-mail: taniguchi.yoshihiko.ny@mail.hosp.go.jp) for deidentified participant data. Reuse of the data is not permitted.

https://doi.org/10.1136/bmjspcare-2020-002480

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    Data availability statement

    Data are available upon reasonable request. Please contact Yoshihiko Taniguchi (E-mail: taniguchi.yoshihiko.ny@mail.hosp.go.jp) for deidentified participant data. Reuse of the data is not permitted.

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    Footnotes

    • Contributors Conceptualisation: YT, AT and YM. Methodology, validation and formal analysis,

      writing of the original draft and visualisation, supervision and project administration: YT. Investigation, provision and data curation: YT, AT, YA, TE, KA and SK. Writing, review and editing: AT, YM, AT and SA.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests YT reports grants and personal fees from Ono Pharmaceutical and Bristol-Myers Squibb and personal fees from Chugai Pharmaceutical and AstraZeneca, all outside the submitted work. AT reports grants and personal fees from Ono Pharmaceutical, Bristol-Myers Squibb and AstraZeneca and personal fees from Chugai Pharmaceutical, Eli Lilly Japan, Taiho Pharmaceutical, MSD, Pfizer, and Boehringer Ingelheim, all outside the submitted work. YA reports personal fees from Daiichi Sankyo Company and Taiho Pharmaceutical, all outside the submitted work. AT reports personal fees from Daiichi Sankyo, Shionogi, Mundipharma, Kirin-Kyowa, and Kracie, all outside the submitted work. SA reports grants and personal fees from Ono Pharmaceutical, Bristol-Myers Squibb, Pfizer, Taiho Pharmaceutical, Chugai Pharmaceutical, AstraZeneca, Eli Lilly, and Boehringer Ingelheim and grants from Yakult Pharmaceutical Industry and MSD, all outside the submitted work. The remaining authors have no disclosures.

    • Provenance and peer review Not commissioned; externally peer reviewed.