Effect of type 2 diabetes mellitus on systemic treatment for advanced non-small cell lung cancer.

BACKGROUND

The effect of type 2 diabetes mellitus (T2DM) on treatments for advanced non-small cell lung cancer (NSCLC) remains unelucidated. We aimed to assess the effect of T2DM on the treatment for advanced NSCLC.

METHODS

We retrospectively investigated clinicopathological character, treatment effect, and adverse events (AEs) in advanced NSCLC patients started on systemic treatment at Nippon Medical School Chiba-Hokusoh Hospital from 2018 to 2024.

RESULTS

The numbers of T2DM and non-T2DM patients among those undergoing immune checkpoint inhibitor (ICI) therapy, molecular targeted therapy (MTT), and cytotoxic chemotherapy (CTT) were 37 and 78, 30 and 86, 9 and 17, respectively. The overall survival (OS) of patients complicated T2DM was significantly worse in total (19.3 . 34.5 months, P=0.001), the ICI (11.5 . 34.2 months, P=0.005) and the MTT cohort (27.4 . 43.4 months, P=0.03). Median progression-free survival (PFS) was significantly poor for T2DM patients in the ICI cohort (5.7 . 12.5 months, P=0.04). However, a significant difference was not found for the MTT cohort (13.3 . 12.7 months, P=0.91). There were no significant differences in AEs in either cohort. Hemoglobin A1c (HbA1c) was significantly higher in patients with derived neutrophil lymphocyte ratio (dNLR) ≥3. The PFS in T2DM patients in the ICI cohort was investigated with regard to clinicopathological factors and T2DM treatments. Specialist consultation was identified as a factor that improved PFS of ICI.

CONCLUSIONS

Our research suggests that T2DM is an independent poor prognostic factor in advanced NSCLC and affects ICI treatment.