Taniguchi Yoshihiko, Tamiya Akihiro, Matsuda Yoshinobu, Adachi Yuichi, Enomoto Takatoshi, Azuma Kouji, Kouno Shunichi, Tokoro Akihiro, Atagi Shinji
Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan.
BMJ Support Palliat Care. 2023 Oct;13(e1):e185-e189. doi: 10.1136/bmjspcare-2020-002480. Epub 2020 Dec 8.
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.
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.
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).
Patients with NSCLC receiving regular opioid administration at nivolumab treatment initiation had a worse nivolumab treatment outcome than patients without opioid use.
阿片类药物常用于缓解癌症相关疼痛。然而，很少有报告评估阿片类药物与非小细胞肺癌（NSCLC）患者免疫检查点抑制剂治疗之间的关联。这项回顾性研究的目的是揭示阿片类药物对接受纳武单抗治疗的NSCLC患者预后的影响。
回顾性分析我院连续接受纳武单抗治疗的NSCLC患者的病历。我们收集了纳武单抗治疗开始时的临床数据。进行倾向评分匹配（PSM）以尽量减少潜在的选择偏倚。我们比较了基线时使用和未使用阿片类药物的患者的临床结局。
在研究中确定的296例患者中，经过PSM后，选择了38例使用阿片类药物的患者和匹配的38例未使用阿片类药物的患者。使用阿片类药物的患者的总缓解率显著低于未使用阿片类药物的患者（2.63%，95%CI 0.47%至13.49%，vs 21.05%，95%CI 11.07%至36.35%；p=0.0284）。使用阿片类药物的患者的无进展生存期显著短于未使用阿片类药物的患者（1.17，95%CI 0.93至1.73个月，vs 2.07，95%CI 1.23至4.73个月；p=0.002）。使用阿片类药物的患者的总生存期显著短于未使用阿片类药物的患者（4.20，95%CI 2.53至6.20个月，vs 9.57，95%CI 2.23至未达到的月数；p=0.018）。
在纳武单抗治疗开始时接受常规阿片类药物治疗的NSCLC患者的纳武单抗治疗结局比未使用阿片类药物的患者更差。
